| Accession Number: | 0000950170-23-065680 |
| Date: | 2023-11-20 |
| Issuer: | PAYMENTUS HOLDINGS, INC. (PAY) |
| Original Submission Date: |
KLEIN JASON
C/O ACCEL-KKR
2180 SAND HILL ROAD, SUITE 300
MENLO PARK, CA 94025
| Title of Security | Transaction Date | 2a. Deemed Execution Date | Transaction Code | Shares | Acquired or Disposed | Price per share | 5. Amount of Securities Beneficially Owned Following Reported Transaction | 6. Ownership Form Direct or Indirect | Nature of Indirect Ownership |
|---|
| Title of Derivative Security | Conversion or Exercise Price of Derivative Security | Transaction Date | Deemed Execution Date | Transaction Code | Number of Derivative Securities Acquired (A) or Disposed of (D) | Date Exercisable | Expiration Date | Title and Amount of Securities Underlying Derivative Security | Price of Derivative Security | Number of derivative Securities Beneficially Owned Following Reported Transaction(s) | Ownership Form: Direct (D) or Indirect (I) | Nature of Indirect Beneficial Ownership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLASS B COMMON STOCK | 0.0 | 2023-11-20 | deemed execution date | J | 12,024 (a) | class a common stock 12,024 | $0.00 | 12,024 | indirect | see footnote |
| ID | footnote |
|---|---|
| f1 | class b common stock is convertible at any time, at the holder's election and automatically in connection with certain transfers and upon certain other events, into an equal number of shares of class a common stock and has no expiration date. |
| f2 | shares received in a pro rata distribution from funds affiliated with accel-kkr. the acquisition of such shares was exempt pursuant to rule 16a-9(a) under the securities exchange act of 1934, as amended. |
| f3 | shares held by the jason and farah klein revocable trust dtd 1/27/2011. |
