U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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
[_] Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person
Bujold, Serge
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(Last) (First) (Middle)
c/o Planet411
440 Rene Levesque West, suite 400
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(Street)
Montreal, Quebec Canada H2Z 1V7
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Planet411.com Inc. PFOO
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
June and September, 2000
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
President and Chief Executive Officer
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7. 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 Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form:
3. (Instr. 3, 4 and 5) Owned at End Direct 7.
2. Transaction ----------------------------- of Issuer's (D) or Nature of
1. Transaction Code (A) Fiscal Year Indirect Indirect
Title of Security Date (Instr. 8) Amount or Price (Instr. 3 (I) Beneficial
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) Ownership
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly. (Put or Type Responses)
(Over)
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. 4. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- Trans- or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action action of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date Code (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ (Instr. 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ 8) ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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2000 Option Plan-
Options to $1.81 06/01/00 A 108,333 3/01/01(1) 3/2/05 Common 108,333 $0.117 D
Purchase Stock
Common Stock
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2000 Option Plan-
Options to $0.687 09/30/00 A 41,667 3/01/01(1) 3/2/05 Common 41,667 $0.117 1,425,000 D
Purchase Stock
Common Stock
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</TABLE>
Explanation of Responses:
(1) Options vest 25% on 3/1/01, 25% on 9/1/01 and 50% on 3/1/02.
/s/ Serge Bujold 12/15/2000
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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. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
