0001874093-21-000001.txt : 20210722 0001874093-21-000001.hdr.sgml : 20210722 20210722090042 ACCESSION NUMBER: 0001874093-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210722 DATE AS OF CHANGE: 20210722 EFFECTIVENESS DATE: 20210722 FILER: COMPANY DATA: COMPANY CONFORMED NAME: PHYTOFORM LABS INC. CENTRAL INDEX KEY: 0001874093 IRS NUMBER: 301212338 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-407243 FILM NUMBER: 211106144 BUSINESS ADDRESS: STREET 1: LAWES OPEN INNOVATION HUB STREET 2: WEST COMMON CITY: HARPENDEN, HERTFORDSHIRE STATE: X0 ZIP: AL5 2JQ BUSINESS PHONE: 44 0 7704 643 551 MAIL ADDRESS: STREET 1: LAWES OPEN INNOVATION HUB STREET 2: WEST COMMON CITY: HARPENDEN, HERTFORDSHIRE STATE: X0 ZIP: AL5 2JQ D 1 primary_doc.xml X0708 D LIVE 0001874093 PHYTOFORM LABS INC. LAWES OPEN INNOVATION HUB WEST COMMON HARPENDEN, HERTFORDSHIRE X0 UNITED KINGDOM AL5 2JQ 44 0 7704 643 551 DELAWARE None None Corporation true 2019 William Pelton Lawes Open Innovation Hub West Common Harpenden, Hertfordshire X0 UNITED KINGDOM AL5 2JQ Executive Officer Director Dhiraj Singh Lawes Open Innovation Hub West Common Harpenden, Hertfordshire X0 UNITED KINGDOM AL5 2JQ Director Nicholas Kral Lawes Open Innovation Hub West Common Harpenden, Hertfordshire X0 UNITED KINGDOM AL5 2JQ Director Other Technology Decline to Disclose 06b false 2021-07-07 false true false 0 5701500 5451498 250002 Total amount sold includes $1,501,500 in Convertible Simple Agreements for Future Equity (SAFEs). false 13 0 0 0 false PHYTOFORM LABS INC. William Pelton William Pelton Chief Executive Officer 2021-07-22