1. Name and Address of Reporting Person*
C/O AMPRIUS TECHNOLOGIES, INC., |
1180 PAGE AVENUE |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 09/14/2022
|
3. Issuer Name and Ticker or Trading Symbol
Amprius Technologies, Inc.
[ AMPX ]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
|
10% Owner |
X |
Officer (give title below) |
|
Other (specify below) |
See Remarks |
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
|
6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
|
|
/s/ Sandra Wallach, attorney-in-fact on behalf of Kang Sun |
09/16/2022 |
|
** 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. |