0001874093-21-000002.txt : 20211124 0001874093-21-000002.hdr.sgml : 20211124 20211124092628 ACCESSION NUMBER: 0001874093-21-000002 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211124 DATE AS OF CHANGE: 20211124 EFFECTIVENESS DATE: 20211124 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/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-407243 FILM NUMBER: 211441466 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/A 1 primary_doc.xml X0708 D/A 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 true 0001874093-21-000001 2021-07-07 false true false 0 5754780 5754777 3 Total amount sold includes $1,501,500 in Convertible Simple Agreements for Future Equity (SAFEs). false 15 0 0 0 false PHYTOFORM LABS INC. /s/ William Pelton William Pelton Chief Executive Officer 2021-11-24