0001652565-17-000002.txt : 20171214 0001652565-17-000002.hdr.sgml : 20171214 20171214121437 ACCESSION NUMBER: 0001652565-17-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20171214 DATE AS OF CHANGE: 20171214 EFFECTIVENESS DATE: 20171214 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Persivia Holdings Inc. CENTRAL INDEX KEY: 0001652565 IRS NUMBER: 473914583 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-300740 FILM NUMBER: 171255627 BUSINESS ADDRESS: STREET 1: 900 CHELMSFORD STREET STREET 2: TOWER 3, 7TH FLOOR CITY: LOWELL STATE: MA ZIP: 01851 BUSINESS PHONE: 978-856-4501 MAIL ADDRESS: STREET 1: 900 CHELMSFORD STREET STREET 2: TOWER 3, 7TH FLOOR CITY: LOWELL STATE: MA ZIP: 01851 D 1 primary_doc.xml X0708 D LIVE 0001652565 Persivia Holdings Inc. 900 CHELMSFORD STREET TOWER 3, 7TH FLOOR LOWELL MA MASSACHUSETTS 01851 978-856-4501 DELAWARE M. Khan Holdings Inc. None Corporation true 2015 Mansoor A. Khan c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Executive Officer Director Fauzia Khan c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Director Ron Zwanziger c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Director Edward Cahill c/o Persivia Holdings Inc. 900 Chelmsford Street, Tower 3, 7th Flr. Lowell MA MASSACHUSETTS 01851 Director Other Decline to Disclose 06b false 2017-11-30 false true false 0 500000 500000 0 false 1 0 0 0 false Persivia Holdings Inc. /s/ Mansoor A. Khan Mansoor A. Khan President 2017-12-11