Sec Form 4 Filing - VedBrat Supurna @ Roadzen Inc. - 2025-02-27

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, 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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1. Name and Address of Reporting Person
VedBrat Supurna
2. Issuer Name and Ticker or Trading Symbol
Roadzen Inc. [ RDZN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O ROADZEN INC., 111 ANZA BLVD. SUITE 109
3. Date of Earliest Transaction (MM/DD/YY)
02/27/2025
(Street)
BURLINGAME, CA94010
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Ordinary Shares 02/27/2025 P 6,000 A $ 1.03 ( 1 ) 18,050 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants $ 11.5 02/27/2025 P 600 ( 2 ) ( 3 ) Ordinary Shares 600 $ 0.06 6,350 D
Convertible Debentures $ 8.5 01/19/2024 12/15/2025 Ordinary Shares 58,823 $ 500,000 D
Warrants ( 4 ) ( 5 ) 03/28/2031 Ordinary Shares 100,000 100,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
VedBrat Supurna
C/O ROADZEN INC.
111 ANZA BLVD. SUITE 109
BURLINGAME, CA94010
X
Signatures
Jean-Noel Gallardo, Attorney-in-fact 03/03/2025
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $1.00 to $1.09, inclusive. The reporting person undertakes to provide to Roadzen Inc., any security holder of Roadzen Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote.
( 2 )The warrants to purchase Ordinary Shares of Roadzen Inc. (the "Public Warrants"), are exercisable for a whole number of Ordinary Shares at any time (subject to certain exceptions provided by the governing warrant agreement).
( 3 )The Public Warrants will expire on September 20, 2028, at 5:00 p.m., New York City time, or earlier upon redemption or liquidation.
( 4 )The exercise price of the warrants reported herein (the "Warrants") is equal to 80% of the lower of (i) the volume-weighted average price ("VWAP") of the ordinary shares of the Issuer, as reported on relevant market or exchange, over the 60 trading days subsequent to the first loan funding under the Notes (as defined below), (ii) the opening price of the Issuer's ordinary shares, as reported on the relevant market or exchange, in any public offering of straight equity securities of the Issuer occurring within six months after the issue date of the warrants and (iii) the VWAP of the Issuer's ordinary shares, as reported on the relevant market or exchange, over the 60 trading days immediately prior to the Vesting Date (as defined below).
( 5 )The Warrants are exercisable in full on March 28, 2025, or earlier under certain circumstances (as applicable, the "Vesting Date").

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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