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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Option | $ 2.5 | 08/01/2005 | M | 73,437 | 01/01/2001 | 12/31/2005 | Forward Industries Common Stock | 73,437 | $ 0 | 251,563 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SCHIFFMAN MICHAEL C/O FORWARD INDUSTRIES INC 1801 GREEN RD. SUITE E POMPANO BEACH, FL 33064 |
X | President & COO |
Jim McKenna, Power of Attorney | 08/03/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Shares: Price: 5000 $28.00 5000 $28.05 5000 $28.10 5000 $28.15 5000 $28.20 5000 $28.25 10000 $28.30 5212 $28.35 5000 $28.40 5000 $28.45 5000 $28.50 5000 $28.55 5000 $28.60 3225 $28.65 |
Remarks: CONFIRMING STATEMENT This Statement confirms that the undersigned, Michael M. Schiffman, has authorized and designated Douglas Sabra and James McKenna, or any one or more of them, to execute and file on the undersigned's behalf all Forms 3, 4 and 5 and Schedules 13D and 13G (including any amendments to any of the foregoing) that the undersigned may be required to file with the U.S. Securities and Exchange Commission as a result of the undersigned's ownership of or transactions in securities of Forward Industries, Inc. This Confirming Statement shall continue until the undersigned is no longer required to file Forms 4 and 5 and/or Schedules 13D or 13G (including amendments to any of the foregoing) with regard to the undersigned's ownership of or transactions in securities of Forward Industries, Inc., unless earlier revoked in writing. The undersigned acknowledges that Douglas Sabra and James McKenna are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. /s/ Michael M. Schiffman July 25, 2005 |