Form preview

Get the free - template

Get Form
FORM 4 Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign template

Edit
Edit your template form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your template form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing template online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use the professional PDF editor, follow these steps:
1
Log in to account. Click Start Free Trial and register a profile if you don't have one yet.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit template. Add and replace text, insert new objects, rearrange pages, add watermarks and page numbers, and more. Click Done when you are finished editing and go to the Documents tab to merge, split, lock or unlock the file.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

What is - Form?

The - is a fillable form in MS Word extension required to be submitted to the specific address to provide certain information. It has to be filled-out and signed, which is possible manually, or using a certain software e. g. PDFfiller. It helps to complete any PDF or Word document right in the web, customize it depending on your purposes and put a legally-binding e-signature. Once after completion, the user can easily send the - to the relevant receiver, or multiple individuals via email or fax. The template is printable as well because of PDFfiller feature and options offered for printing out adjustment. Both in digital and in hard copy, your form should have a organized and professional outlook. It's also possible to save it as the template for later, there's no need to create a new file from the beginning. All you need to do is to edit the ready template.

Template - instructions

Once you're ready to begin filling out the - form, you ought to make certain all required info is well prepared. This very part is highly significant, as long as errors may cause unpleasant consequences. It is unpleasant and time-consuming to re-submit the entire editable template, letting alone the penalties came from missed due dates. To handle the digits requires more concentration. At first sight, there is nothing challenging in this task. However, there's nothing to make a typo. Professionals recommend to store all sensitive data and get it separately in a file. Once you have a sample, you can easily export that information from the file. Anyway, you ought to pay enough attention to provide true and correct information. Doublecheck the information in your - form while filling all important fields. In case of any mistake, it can be promptly corrected with PDFfiller editor, so that all deadlines are met.

-: frequently asked questions

1. I need to fill out the file with very sensitive data. Shall I use online solutions to do that, or it's not that safe?

Services working with sensitive information (even intel one) like PDFfiller do care about you to be confident about how secure your documents are. They include the following features:

  • Cloud storage where all information is kept protected with basic an layered encryption. The user is the only one that has got to access their personal documents. Disclosure of the information by the service is strictly prohibited.
  • To prevent document falsification, each file receives its unique ID number upon signing.
  • If you think that's not enough for you, set additional security features you prefer then. They manage you to request the two-factor verification for every user trying to read, annotate or edit your file. PDFfiller also offers specific folders where you can put your - word form and secure them with a password.

2. Is electronic signature legal?

Yes, it is totally legal. After ESIGN Act concluded in 2000, an e-signature is considered as a legal tool. You can complete a word file and sign it, and to official businesses it will be the same as if you signed a hard copy with pen, old-fashioned. While submitting - form, you have a right to approve it with a digital solution. Be sure that it suits to all legal requirements as PDFfiller does.

3. I have a sheet with some of required information all set. Can I use it with this form somehow?

In PDFfiller, there is a feature called Fill in Bulk. It helps to make an extraction of data from the available document to the online template. The big yes about this feature is, you can use it with Microsoft Excel spreadsheets.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.4
Satisfied
58 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

In your inbox, you may use pdfFiller's add-on for Gmail to generate, modify, fill out, and eSign your template and any other papers you receive, all without leaving the program. Install pdfFiller for Gmail from the Google Workspace Marketplace by visiting this link. Take away the need for time-consuming procedures and handle your papers and eSignatures with ease.
Yes. With pdfFiller for Chrome, you can eSign documents and utilize the PDF editor all in one spot. Create a legally enforceable eSignature by sketching, typing, or uploading a handwritten signature image. You may eSign your template in seconds.
Install the pdfFiller app on your iOS device to fill out papers. Create an account or log in if you already have one. After registering, upload your template. You may now use pdfFiller's advanced features like adding fillable fields and eSigning documents from any device, anywhere.
Fill out your template online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.