SEC 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
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O FRANCESCA'S HOLDINGS CORPORATION|
|8760 CLAY ROAD|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Francesca's Holdings CORP
[ FRAN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||/s/ Kal Malik, as attorney-in-fact
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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.|
POWER OF ATTORNEY
FOR SEC FILINGS ON FORMS ID, 3, 4, 5 AND 144
IN RESPECT OF SECURITIES OF
FRANCESCA'S HOLDINGS CORPORATION
The undersigned hereby constitutes and appoints Kal Malik
as his true and lawful attorney-in-fact and agent, with full power of
substitution and resubstitution for his in his name and stead in any and all
capacities, to sign and file for and on his behalf, in respect of any
acquisition, disposition or other change in ownership of any Common Stock of
Francesca's Holdings Corporation (the "Company"), the following:
(i) any Form ID to be filed with the Securities and Exchange
Commission (the "SEC");
(ii) any Initial Statement of Beneficial Ownership of Securities
on Form 3 to be filed with the SEC;
(iii) any Statement of Changes of Beneficial Ownership of
Securities on Form 4 to be filed with the SEC;
(iv) any Annual Statement of Beneficial Ownership of Securities
on Form 5 to be filed with the SEC;
(v) any Notice of Proposed Sale of Securities on Form 144 to be
filed with the SEC; and
(vi) any and all agreements, certificates, receipts, or other
documents in connection therewith.
The undersigned hereby gives full power and authority to the
attorney-in-fact to seek and obtain as the undersigned's representative
on the undersigned's behalf, information on transactions in the Company's
securities from any third party, including brokers, employee benefit plan
administrators and trustees, and the undersigned hereby authorizes any such
person to release such information to the undersigned and approves and
ratifies any such release of information.
The undersigned hereby grants unto such attorney-in-fact and
agent full power and authority to do and perform each and every act and thing
requisite and necessary in connection with such matters and hereby ratifies
and confirms all that any such attorney-in-fact and agent or substitute may
do or cause to be done by virtue hereof.
The undersigned acknowledges that:
(i) neither the Company nor such attorney-in-fact assumes (i)
any liability for the undersigned's responsibility to comply
with the requirement of the Securities Exchange Act of 1934,
as amended (the "Exchange Act"), (ii) any liability of the
undersigned for any failure to comply with such requirements
or (iii) any obligation or liability of the undersigned for
profit disgorgement under Section 16(b) of the Exchange Act; and
(ii) this Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's
obligations under the Exchange Act, including without limitation
the reporting requirements under Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect
until revoked by the undersigned in a signed writing delivered to such
IN WITNESS WHEREOF, the undersigned has executed this Power
Date: April 6, 2017 /s/ Philip Bleser