| FORM
4 |
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
or Section 30(h) of the Investment Company Act of
1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Expires: |
December 31, 2014 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
|
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue.
See
Instruction 1(b).
|
1. Name and Address of Reporting Person
*
| C/O QUOTIENT TECHNOLOGY INC. |
| 400 LOGUE AVENUE |
(Street)
|
2. Issuer Name
and
Ticker or Trading Symbol
Quotient Technology Inc.
[
QUOT
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| President and CEO |
|
3. Date of Earliest Transaction
(Month/Day/Year)
10/24/2016
|
4. 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 Acquired, Disposed of, or
Beneficially Owned |
|---|
| 1.
Title of Security (Instr.
3)
|
2.
Transaction Date
(Month/Day/Year) |
2A.
Deemed Execution Date, if any
(Month/Day/Year) |
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 |
|
Common Stock
|
10/25/2016 |
10/25/2016 |
S |
|
49,345
|
D
|
$
11.2691
|
313,817
|
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
(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 Securities Underlying Derivative Security (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: 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 |
| Explanation of Responses: |
|
|
|
|
/s/Margaret Tong Atty-in-Fact for Mir Aamir |
10/25/2016 |
|
** 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
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). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| 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 Number. |
LIMITED POWER OF ATTORNEY - SECTION 16 REPORTING PURPOSES
Know all by these present, that the undersigned hereby makes,
constitutes and appoints each of Connie Chen, Ronald Fior and
Margaret Tong, acting individually,as the undersigneds
true and lawful attorney
in fact, with full power and authority as hereinafter
described on behalf of and in the name, place and stead of
the undersigned to:
1. execute for, and on behalf of, the undersigned, in
the undersigneds capacity as an officer andor director
of Quotient Technology Inc. (fka Coupons.com Incorporated)
(the Company), Forms 3, 4 and 5 in accordance with Section
16(a) of the Securities Exchange Act of 1934, as amended, and
the rules and regulations promulgated thereunder (the Exchange Act);
2. seek or obtain, as the undersigneds representative and
on the undersigneds behalf, information on transactions in the
Companys securities from any third party, including brokers,
employee benefit plan administrators and trustees, and the
undersigned hereby authorizes any such person to release any
such information to any attorney in fact and further approves
and ratifies any such release of information;
3. do and perform any and all acts for and on behalf of
the undersigned which may be necessary or desirable to prepare,
complete and execute any such Form 3, 4 or 5, and any amendments
thereto, or other required report and timely file such Forms or
reports with the United States Securities and Exchange Commission,
the New York Stock Exchange, NASDAQ Capital Market and any stock
exchange or similar authority as considered necessary or advisable
under Section 16(a) of the Exchange Act; and
4. take any other action of any type whatsoever in connection with
the foregoing which, in the opinion of such attorney in fact, may
be of benefit to, in the best interest of, or legally required by,
the undersigned, it being understood that the documents executed by
such attorney in fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such terms
and conditions as such attorney in fact may approve in such
attorney in facts sole discretion.
The undersigned hereby acknowledges that (a) the foregoing
attorneys in fact are serving in such capacity at the request of the
undersigned; (b) this Limited Power of Attorney authorizes, but does
not require, each such attorney in fact to act in his or her discretion
on information provided to such attorney in fact without independent
verification of such information; (c) any documents prepared andor
executed by any attorney in fact on behalf of the undersigned pursuant
to this Limited Power of Attorney shall be in such form and shall
contain such information and disclosure as such attorney in fact,
in his or her sole discretion, deems necessary or advisable;
(d) neither the Company nor any attorney in fact assumes
(i) any liability for the undersigneds responsibility to comply
with the requirements of the Exchange Act, (ii) any liability of
the undersigned for any failure to comply with such requirements,
or (iii) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act; and (e) this
Limited Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigneds obligations
under the Exchange Act, including, without limitation, the reporting
requirements under Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until
the undersigned is no longer required to file Forms 3, 4 and 5 with
respect to the undersigneds holdings of and transactions in,
securities issued by the Company, unless earlier revoked as to any
attorney in fact by the undersigned in a signed writing delivered
to such attorney in fact.
IN WITNESS WHEREOF, the undersigned has executed this Limited Power
of Attorney as of this 11th day of October, 2016.
Signature: Mir Amir
Print Name: Mir Amir
Tweet
Share
E-mail
