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Form 4 DOCUMENT SECURITY SYSTEM For: Jun 21 Filed by: Chan Heng Fai Ambrose

June 23, 2021 9:41 PM EDT
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
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OMB Number: 3235-0287
Expires: December 31, 2014
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 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 *
Chan Heng Fai Ambrose
(Last) (First) (Middle)
C/O DOCUMENT SECURITY SYSTEMS, INC.
6 FRAMARK DRIVE
(Street)
VICTOR NY 14564
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
DOCUMENT SECURITY SYSTEMS INC [ DSS ] 		5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/21/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
 6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X 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 06/21/2021   C (1)   1,120,170 A (2) 10,036,164 (3) I See footnote (4)
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
Series A Convertible Preferred Stock (2) 06/21/2021   C (1)     7,259   (2)   (2) Common Stock 1,120,170 (2) 0 I See footnote (4)
Explanation of Responses:
1. Global BioMedical Pte. Ltd. ("GBM") has converted 7,259 shares of Series A Convertible Preferred Stock into 1,120,170 shares of the common stock, par value $0.02 per share (the "Common Stock"), of Document Security Systems, Inc. (the "Issuer").
2. The Series A Convertible Preferred Stock of the Issuer has a stated value of $1,000 per share and may be converted into shares of the Common Stock of the Issuer at a conversion price of $6.48 per share. Following the conversion of 7,259 shares of Series A Convertible Preferred Stock, GBM does not own any shares of Series A Convertible Preferred Stock. Mr. Chan has dispositive control over the securities owned by GBM.
3. The beneficial ownership of the Reporting Person includes 10,036,164 shares of Common Stock, consisting of (a) 1,614,552 shares of Common Stock held by Heng Fai Holdings Limited; (b) 16,667 shares of Common Stock held by BMI Capital Partners International Limited; (c) 474,060 shares of Common Stock held by the Reporting Person; (d) 214,881 shares of Common Stock held by LiquidValue Development Pte Ltd.; and (e) 7,716,004 shares of Common Stock held by Global Biomedical Pte. Ltd.
4. These securities were owned directly by GBM. Mr. Chan has dispositive control over the securities of the Issuer owned by GBM.
/s/ Heng Fai Ambrose Chan 06/23/2021
** Signature of Reporting Person Date
/s/ Global BioMedical Pte. Ltd by Heng Fai Ambrose Chan 06/23/2021
** 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.

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