SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Salem Enrique T

(Last) (First) (Middle)
C/O BAIN CAPITAL VENTURE INVESTORS, LLC
200 CLARENDON STREET

(Street)
BOSTON MA 02116

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/26/2018
3. Issuer Name and Ticker or Trading Symbol
DOCUSIGN INC [ DOCU ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 57,111 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Redeemable Convertible Series B Preferred Stock (1) (1) Common Stock 18,498 (1) I See footnotes(4)(5)
Redeemable Convertible Series B-1 Preferred Stock (1) (1) Common Stock 5,541 (1) I See footnotes(4)(5)
Redeemable Convertible Series D Preferred Stock (1) (1) Common Stock 1,916,890 (1) I See footnotes(4)(5)
Redeemable Convertible Series D Preferred Stock (1) (1) Common Stock 89,811 (1) I See footnote(6)
Redeemable Convertible Series E Preferred Stock (1) (1) Common Stock 343,417 (1) I See footnotes(4)(5)
Redeemable Convertible Series F Preferred Stock (1) (1) Common Stock 3,011,559 (1) I See footnotes(4)(5)
Option (Right to Buy) (2) 07/25/2023 Common Stock 40,000 $2.14 D
Option (Right to Buy) (3) 03/10/2025 Common Stock 10,000 $13.43 D
Explanation of Responses:
1. These shares of redeemable convertible preferred stock are convertible, at the option of the holder, into shares of Common Stock on a 1-for-1 basis and will automatically convert into shares of Common Stock on a 1-for-1 basis immediately upon the closing of the Issuer's initial public offering. These shares of redeemable convertible preferred stock have no expiration date.
2. All shares underlying this option have vested.
3. 7,708 of the shares underlying this option have vested. The remaining 2,292 shares will vest in 11 monthly installments beginning on May 10, 2018, subject to Mr. Salem's continued service through each vesting date.
4. Represents shares of redeemable convertible preferred stock held directly by BCIP Venture Associates, BCIP Venture Associates-B, BCIP Venture Associates II, LP, BCIP Venture Associates II-B, LP, Bain Capital Venture Fund 2012, L.P., Bain Capital Venture Fund 2014, L.P. and Bain Capital Venture Coinvestment Fund, L.P. (collectively, the "Bain Venture Entities).
5. The governance, investment strategy and decision-making process with respect to the investments held by the Bain Venture Entities is directed by the Executive Committee of Bain Capital Venture Investors, LLC ("BCVI"). Mr. Salem is a Managing Director of BCVI. By virtue of the relationships described in this footnote, Mr. Salem may be deemed to share voting and dispositive power with respect to all of the shares of redeemable convertible preferred stock held by the Bain Venture Entities. Mr. Salem disclaims beneficial ownership except to the extent of his pecuniary interest therein.
6. Represents shares of redeemable convertible preferred stock held directly by NPI Capital, LLC. Mr. Salem is the managing member of NPI Capital, LLC.
Remarks:
/s/ Enrique T. Salem 04/26/2018
** Signature of Reporting Person Date
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, see Instruction 5 (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).
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