Samson Helfgott - Form 4

FORM 4

 

*  Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

(Print or Type)

 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940

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1.  Name and Address of Reporting Person*

 

Helfgott, Samson

2.  Issuer Name and Tickler or Trading Symbol

Forward Industries Inc. (FORD)

 

6.  Relationship of Reporting Person(s) to Issuer

(Check all applicable)

  X_  Director    ___  10% Owner    _ _  Officer (give title below)    ___  Other (specify below)

______________________________

(Last)     (First)     (Middle)

1801 Green Road, Suite E.

3.  I.R.S. Identification Number of Reporting Person, if an entity (voluntary)

 

4.  Statement for Month/Year

February 2002

(Street)

 

 

Pompano Beach, FL 33064

5.  If Amendment, Date of Original (Month/Year)

 

7.  Individual or Joint/Group Filing (Check Applicable Line)

_X_  Form filed by One Reporting Person

___  Form filed by More than One Reporting Person

 

(City)     (State)     (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.  Title of Security
(Instr. 3)

 

2.  Transaction Date

(Month/Day/Year)

3.  Transaction Code
(Instr. 8)

 

4.  Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)

 

5.  Amount of Securities Beneficially
 Owned at End of Month
(Instr. 3 and 4)

 

6.  Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)

 

7.  Nature of Indirect Beneficial Ownership
(Instr. 4)

 

Code

V

Amount

(A) or (D)

Price

Common Stock

02/15/2002

P

  

3,000

A

$1.00

3,000

  

D

  
                 

D

  
                 

D

  
                     
                     

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1.  Title of Derivative Security
(Instr.3)

 

2.  Conversion or Exercise Price of Derivative Security

 

3.  Transaction Date
(Month/Day/Year)

 

4.  Transaction Code
(Instr. 8)

 

5.  Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

 

6.  Date Exerciseable and Expiration Date
(Month/Day/Year)

 

7.  Title and Amount of Underlying Securities
(Instr. 3 and 4)

 

8.  Price of Derivative Security
(Instr. 5)

 

9.  Number of Derivative Securities Beneficially Owned at End of Month
(Instr. 4)

 

10.  Ownership Form of Derivative Securities Beneficially Owned at End of Month
(Instr. 4)

 

11.  Nature of Indirect Beneficial Ownership
(Instr. 4)

 

Code

V

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Common Stock Option

                      

10,000

D

  
                             
                             

Explanation of Responses:


 

          /s/ Samson Helfgott              
**Signature of Reporting Person

March 5, 2002
_______________________
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 4(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, on of which must be manually signed. If space is insufficient, see Instruction 6 for procedure