SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
DABAH EZRA

(Last) (First) (Middle)
C/O 200 PARK AVE SOUTH, 3RD FLOOR

(Street)
NEW YORK NY 10003

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/10/2021
3. Issuer Name and Ticker or Trading Symbol
KIDPIK CORP. [ PIK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
President, CEO and Chairman
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 1,925,770 D
Common Stock 252,967(1) I Through spouse
Common Stock 1,508,408(2) I See Notes(3)(6)
Common Stock 365,024(2) I See Notes(4)(6)
Common Stock 1,103,124(2) I See Notes(5)(6)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The reported securities are held directly by Renee Dabah, the spouse of the Reporting Person, and are also separately reported in a Form 3 (and will be reported in Form 4s) filed by Mrs. Dabah.
2. The Reporting Person was provided complete authority to vote these shares pursuant to a voting agreement dated September 1, 2021, with (and with respect to the reported securities owned by) Moshe Dabah, Eva Dabah, Joia Kazam, Chana Rapaport, Yaacov Dabah; Trust FBO Josh A. Kazam, whose trustee is Greg Kiernan; Gila Goodman; Isaac Dabah and his spouse; GMM Capital LLC; Sterling Macro Fund, and each of the trusts described in note (2) below, at any and all meetings of stockholders of the Company and via any written consents. The voting agreement has a term of three years, through August 31, 2024, but can be terminated at any time by Mr. Dabah and terminates automatically upon the death of Mr. Dabah.
3. Includes securities held in the name of the u/a/d 02/02/1997, Trust FBO Yaacov Dabah; the u/a/d 02/02/1997, Trust FBO Moshe Dabah; the u/a/d 02/02/1997, Trust FBO Joia Dabah; the u/a/d 02/02/1997, Trust FBO Eva Dabah and the u/a/d 02/02/1997, Trust FBO Chana Dabah, each of which are party to the voting agreement described in (1) above, and each of which the spouse of Mr. Ezra Dabah serves as co-trustee of, along with the mother-in-law of Ezra Dabah (Raine Silverstein), and which securities held by such trusts, Mr. Ezra Dabah may be deemed to beneficially own. These securities are also separately reported in a Form 3 (and will be reported in Form 4s) filed by Mrs. Dabah and Mrs. Silverstein.
4. Includes securities held in the name of Moshe Dabah, Eva Dabah, Joia Kazam, Chana Rapaport, and Yaacov Dabah, each of whom are party to the voting agreement described (1) above, and each of which holders are the adult children of Mr. Ezra Dabah, and which securities held by such persons Mr. Ezra Dabah may be deemed to beneficially own. The securities held by Moshe Dabah are also separately reported in a Form 3 (and will be reported in Form 4s) filed by Mr. Moshe Dabah, an executive officer of the Issuer. agreement described (1) above, and each of which holders are the adult children of Mr. Ezra Dabah, and which securities held by such persons Mr. Ezra Dabah may be deemed to beneficially own. The securities held by Moshe Dabah are also separately reported in a Form 3 (and will be reported in Form 4s) filed by Mr. Moshe Dabah, an executive officer of the Issuer.
5. Includes securities held by an irrevocable trust in the name of Josh A. Kazam, the son-in-law of Mr. Ezra Dabah, Irrevocable Trust, whose trustee is Greg Kiernan; Gila Goodman, who is the sister of Ezra Dabah; Isaac Dabah, who is the brother of Ezra Dabah and his spouse; GMM Capital LLC, an entity which Isaac Dabah controls; and Sterling Macro Fund, an entity which Isaac Dabah controls, each of whom are party to the voting agreement described (2) above, and which securities held by such persons Mr. Ezra Dabah may be deemed to beneficially own.
6. The reporting person disclaims ownership of the reported securities except to the extent of his own pecuniary interest therein.
/s/ Ezra Dabah 12/03/2021
** 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 5 (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.