DSS, INC. — Director's Dealing 2017

Sep 14, 2017

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: DOCUMENT SECURITY SYSTEMS INC (DSS)
CIK: 0000771999
Period of Report: 2017-09-12

Reporting Person: Chan Heng Fai Ambrose (Director, 10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2017-09-12	Common Stock	F	200000	$0.75	Acquired	500000	Indirect
2017-09-12	Common Stock	J	683000	—	Acquired	683000	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2017-09-12	Warrant to Purchase Common Stock	$0.75	F	200000	Acquired	2019-12-29	Common Stock (200000)	Indirect

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	800000	Indirect
Common Stock	2612	Direct

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Warrant to Purchase Common Stock	$1.00	2022-09-08	Common Stock (160000)	160000	Indirect

Footnotes

F1: Held by BMI Capital Partners International Limited., of which the Reporting Person is a director. The Reporting Person has dispositive control over these securities.

F2: Held by Hengfai Business Develoment Pte Ltd., of which the Reporting Person is the Chief Executive Officer and the owner. The Reporting Person has dispositive control over these securities.

F3: Held by Heng Fai Holdings Limited, of which the Reporting Person is an Officer and the owner. The Reporting Person has dispositive control over these securities.

F4: As consideration for the shares of the Issuer acquired on 09/12/2017 and that were valued at $0.71 per share, Hengfai Business Develoment Pte Ltd. exchanged securities of an entity listed on the Singapore Exchange Limited.