SEC Form 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:
||Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
1. Name and Address of Reporting Person*
|C/O DAVE INC.|
|750 N. SAN VICENTE BLVD. 900W|
2. Issuer Name and Ticker or Trading Symbol
[ DAVE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
3. Date of Earliest Transaction
4. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned|
|1. Title of Security (Instr.
||2. Transaction Date
||2A. Deemed Execution Date, if any
||3. Transaction Code (Instr.
||4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
||6. Ownership Form: Direct (D) or Indirect (I) (Instr.
||7. Nature of Indirect Beneficial Ownership (Instr.
||(A) or (D)
|Class A Common Stock
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Conversion or Exercise Price of Derivative Security
||3. Transaction Date
||3A. Deemed Execution Date, if any
||4. Transaction Code (Instr.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
||6. Date Exercisable and Expiration Date
||7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
||8. Price of Derivative Security (Instr.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
||10. Ownership Form: Direct (D) or Indirect (I) (Instr.
||11. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/ John Ricci, as Attorney-in-Fact
||** Signature of Reporting Person
|Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.|
|* If the form is filed by more than one reporting person,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).|
|Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.|
|Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.|
POWER OF ATTORNEY
The undersigned as a Section 16 reporting person of Dave, Inc. (the "Company"),
hereby constitutes and appoints
Kyle Beilman and John Ricci, and each of them, the undersigned's true and lawful
attorney in fact to:
(1) execute, deliver and file for and on behalf of the undersigned, in the
undersigned's capacity as
an officer and/or director of the Company, Forms 3, 4, and 5 in accordance with
Section 16(a) of the Exchange Act;
(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or
desirable to complete and execute any such Form 3, 4, or 5, complete and execute
any amendment or amendments
thereto, and timely file such form with the SEC and any stock exchange or
(3) seek or obtain, as the undersigned's representative and on the undersigned's
information on transactions in the Company's securities from any third party,
including brokers, employee benefit plan administrators
and trustees, and the undersigned hereby authorizes any such person to release
any such information to the undersigned and
approves and ratifies any such release of information; and
(4) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney in fact,
may be of benefit to, in the best interest of, or legally required by, the
undersigned, it being understood that the documents
executed by such attorney in fact on behalf of the undersigned pursuant to this
Power of Attorney shall be
in such form and shall contain such terms and conditions as such attorney in
fact may approve in such attorney in fact's discretion.
The undersigned hereby grants to each such attorney in fact full power and
authority to do and perform any and
every act and thing whatsoever requisite, necessary, or proper to be done in the
exercise of any of the rights and powers herein granted,
as fully to all intents and purposes as the undersigned might or could do if
personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney in fact, or such attorney
in fact's substitute or substitutes,
shall lawfully do or cause to be done by virtue of this power of attorney and
the rights and powers herein granted.
The undersigned acknowledges that the foregoing attorneys in fact, in serving in
such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act. The undersigned further acknowledges
and agrees that the attorney-in-fact and the Company are relying on written and
oral information provided by the undersigned to complete such forms and
the undersigned is responsible for reviewing the completed forms prior to their
filing. The attorney-in-fact and the Company are not responsible for
any errors or omissions in such filings. The attorney-in-fact and the Company
are not responsible for determining whether or not the transactions reported
could be matched with any other transactions for the purpose of determining
liability for short-swing profits under Section 16(b).
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to the Company and the foregoing attorneys in fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of January 5, 2022.
/s/ Brendan Carroll
Name: Brendan Carroll