SEC FORM
3
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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| OMB Number: |
3235-0104 |
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| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
12/18/2013
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3. Issuer Name and Ticker or Trading Symbol
M/A-COM Technology Solutions Holdings, Inc.
[ MTSI ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| SVP and General Manager, HPA |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Employee Stock Option (Right to Buy) |
|
02/10/2020 |
Common Stock |
6,688 |
19.45 |
D |
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| Employee Stock Option (Right to Buy) |
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11/05/2018 |
Common Stock |
4,037 |
19.82 |
D |
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| Employee Stock Option (Right to Buy) |
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11/15/2015 |
Common Stock |
645 |
21.68 |
D |
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| Employee Stock Option (Right to Buy) |
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04/28/2019 |
Common Stock |
6,782 |
27.03 |
D |
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| Explanation of Responses: |
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/s/ Clay Simpson, Attorney-in-Fact |
12/27/2013 |
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** 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. |
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POWER OF ATTORNEY
I, Najabat Bajwa, hereby authorize and designate each of Robert
McMullan, Clay Simpson, Steve Coen, and Jason Day, signing singly, as my
true and lawful attorney-in-fact to:
(1) execute for and on my behalf, in my capacity as an officer
and/or director of M/A-COM Technology Solutions Holdings, Inc. and its
affiliates (the "Company"), the Form ID and Forms 3, 4 and 5 in
accordance with Section 16(a) of the Securities Exchange Act of 1934, as
amended (the "Exchange Act") and the rules and regulations promulgated
thereunder;
(2) do and perform any and all acts for and on my behalf which
may be necessary or desirable to complete and execute any such Form ID or
Form 3, 4 or 5 and timely file such form with the Securities and Exchange
Commission, any stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection
with the foregoing which, in the opinion of such attorney-in-fact, may be
to my benefit, in my best interest, or legally required of me, it being
understood that the statements executed by such attorney-in-fact on my
behalf pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
I hereby further grant to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the
rights and powers herein granted, as fully to all intents and purposes as
I might or could do if personally present, with full power of substitutes
or revocation, hereby ratifying and confirming all that such attorney-in
fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this Power of Attorney and
the rights and powers herein granted. I hereby acknowledge that the
foregoing attorneys-in-fact, in serving in such capacity at my request,
are not assuming, nor is the Company assuming, any of my responsibilities
to comply with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until
I am no longer required to file the Form ID or Forms 3, 4 and 5 with
respect to my holdings of and transactions in securities issued by the
Company, unless earlier revoked by me in a signed writing delivered to
the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, I have caused this Power of Attorney to be duly
executed as of this 20th day of December, 2013.
/s/ Najabat Bajwa
Najabat Bajwa
