Initial Statement of Beneficial Ownership (3)
05 Maio 2023 - 6:09PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Rmaile Hassan |
2. Date of Event Requiring Statement (MM/DD/YYYY)
4/27/2023
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3. Issuer Name and Ticker or Trading Symbol
Avery Dennison Corp [AVY]
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(Last)
(First)
(Middle)
8080 NORTON PARKWAY |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
President, Materials Group / |
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(Street)
MENTOR, OH 44060
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 | 13370 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| 2020 MSU Award | 3/1/2021 (1) | 3/1/2024 | Common Stock | 579 | $0 | D | |
| 2020 RSU Award | 12/1/2023 (2) | 12/1/2023 | Common Stock | 3314 | $0 | D | |
| 2021 MSU Award | 3/1/2022 (1) | 3/1/2025 | Common Stock | 640 | $0 | D | |
| 2021 PU Award | 3/1/2024 (3) | 3/1/2024 | Common Stock | 1522 | $0 | D | |
| 2022 MSU Award | 3/1/2023 (1) | 3/1/2026 | Common Stock | 1415 | $0 | D | |
| 2022 PU Award | 3/1/2025 (4) | 3/2/2025 | Common Stock | 1462 | $0 | D | |
| 2022 RSU Award | 3/1/2025 (2) | 3/1/2025 | Common Stock | 8793 | $0 | D | |
| 2023 MSU Award | 3/1/2024 (1) | 3/1/2027 | Common Stock | 2805 | $0 | D | |
| 2023 PU Award | 3/1/2026 (5) | 3/1/2026 | Common Stock | 2914 | $0 | D | |
| Explanation of Responses: |
| (1) | Market-leveraged stock units vest 25% over one-, two-, three- and four-year performance periods, with the number of shares paid on each vesting date based on the percentage change in the Company's stock price, plus dividend equivalents accrued during the vesting period. Each market-leveraged stock unit represents a contingent right to receive one share of common stock, plus accrued dividend equivalents. |
| (2) | The restricted stock units cliff vest on the third anniversary of the grant date. Each restricted stock unit represents a contingent right to receive one share of common stock. |
| (3) | Performance units vest, if at all, at the end of fiscal year 2023, provided certain performance objectives are met as determined by the Compensation Committee in February 2024. Each performance unit represents a contingent right to receive one share of common stock |
| (4) | Performance units vest, if at all, at the end of fiscal year 2024, provided certain performance objectives are met as determined by the Compensation Committee in February 2025. Each performance unit represents a contingent right to receive one share of common stock |
| (5) | Performance units vest, if at all, at the end of fiscal year 2025, provided certain performance objectives are met as determined by the Compensation Committee in February 2026. Each performance unit represents a contingent right to receive one share of common stock |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Rmaile Hassan
8080 NORTON PARKWAY
MENTOR, OH 44060 |
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| President, Materials Group |
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Signatures
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| /s/ Vikas Arora, attorney-in-fact for Hassan Rmaile | | 5/5/2023 |
| **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 control number. |
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