DSS, INC. — Director's Dealing 2019

Feb 20, 2019

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: DOCUMENT SECURITY SYSTEMS INC (DSS)
CIK: 0000771999
Period of Report: 2019-02-18

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

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2019-02-18	Convertible Promissory Note	$1.12	P	446428	Acquired	2020-02-18	Common (446428)	Indirect

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	1786531	Indirect
Common Stock	500000	Indirect
Common Stock	683000	Indirect
Common Stock	2912	Direct

Footnotes

F1: Held by Heng Fai Holdings Limited of which Reporting Person is the owner. The Reporting Person has dispositive control over these securities.

F2: Held by BMI Capital Partners International Limited of which the Reporting Person is an owner and director. The Reporting Person has dispositive control over these securities.

F3: Held by Hengfai Business Development Pte Ltd of which Reporting Person is the Chief Executive Officer and Owner. The Reporting Person has dispositive control over these securities.

F4: This Convertible Promissory Note in the amount of $500,000, convertible into 446,428 shares of Common Stock, is held by LiquidValue Development Pte Ltd of which Reporting Person is the owner and a director. The Reporting Person has dispositive control over these securities.