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FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE
COMMISSION |
OMB APPROVAL OMB NUMBER: 3235-0104 Expires: October 31, 2001 Estimated average burden hours per response...............0.5 |
(Print or Type Responses) |
1. Name and Address
of Reporting Person* _Hashemi Majid M (Last) (First) (Middle) _____ _P. O. Box 20577___ _____ (Street) _San Jose CA 95160 (City) (State) (Zip) |
2. Date of
Event Requiring Statement (Month/Day/Year) [12/01/00] |
4. Issuer Name and
Ticker or Trading
Symbol National Scientific Corporation NSCT.OB | |
5. Relationship of
Reporting Person(s) to
Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X ] Officer (give [ ] Other (specify title below) below) President |
6. If Amendment, Date of
Original (Month/Day/Year) [mm/dd/yy] | ||
3. I.R.S.
Identification Number of Reporting Person, if an entity (voluntary) [IRS ID #] |
7. Individual or Joint/Group
Filing (Check Applicable Line) [ X] 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. 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 | 1,425,000 | (D) | Officer |
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).
Potential persons who are to 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.
(OVER)
SEC 1473 (7-97)
FORM 3 (continued)
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) |
1. Title of
Derivative Security (Instr. 4) |
2. Date Exercisable
and Expiration Date (Month/Date/Year) |
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 | ||||
Explanation of Responses: | |||
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/s/ Majid M. Hashemi | 12/13/00 | ||
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**Signature of Reporting Person | Date |
** Intentional misstatements or omissions of facts constitute
Federal Criminal Violations.
See 18
U.S.C. 1001 and 15 U.S.C. 7811(a).
Note: File three copies of this Form, one of which must be
manually signed. If space is insufficient,
See
Instruction 6 for procedure.
Potential persons who are to respond to the collection of
information contained in this form are not required
to respond unless the
form displays a currently valid OMB Number.
PAGE 2
SEC 1473(7-97)
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