SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|PACIFIC BIOSCIENCES OF CALIFORNIA, INC.,|
|1305 O'BRIEN DRIVE|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
PACIFIC BIOSCIENCES OF CALIFORNIA, INC.
[ PACB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|Chief Operating Officer||
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||/s/ Eric Schaefer, Attorney-in-fact
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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.|
FORM 3 (continued)
POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person
of Pacific Biosciences of California, Inc. (the "Company"),
hereby constitutes and appoints Eric Schaefer, Susan Kim,
Brett Atkins, Donna Petkanics and Andrew Hoffman,
and each of them, the undersigned's true and lawful
1. complete and execute Forms 3, 4 and 5 and other
forms and all amendments thereto as such attorney-in-fact
shall in his or her discretion determine to be required or
advisable pursuant to Section 16 of the Securities Exchange
Act of 1934 (as amended) and the rules and regulations promulgated
thereunder, or any successor laws and regulations, as a
consequence of the undersigned's ownership, acquisition
or disposition of securities of the Company; and
2. do all acts necessary in order to file such forms
with the U.S. Securities and Exchange Commission, any
securities exchange or national association, the
Company and such other person or agency as the
attorney-in-fact shall deem appropriate.
The undersigned hereby ratifies and confirms all
that said attorneys-in-fact and agent shall do
or cause to be done by virtue hereof. The undersigned
acknowledges that the foregoing attorneys-in-fact,
in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company
assuming, any of the undersigned's responsibilities
to comply with Section 16 of the Securities Exchange
Act of 1934 (as amended).
This Power of Attorney shall remain in full force
and effect until the undersigned is no longer required
to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in
securities issued by the Company, unless earlier
revoked by the undersigned in a signed writing
delivered to the Company and the
IN WITNESS WHEREOF, the undersigned has caused
this Power of Attorney to be executed as of
7th of January, 2021.
Signature: /s/ Mark Van Oene
Name: Mark Van Oene