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FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
Washington, D.C. 20549
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/_/ Check box if no longer subject to ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0362
Section 16. Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities Exchange Act Expires: September 30, 1998
obligations may continue. SEE of 1934, Section 17(a) of the Public Utility Holding Estimated average burden hours
Instruction 1(b). Company Act of 1935 or Section 30(f) of the Investment per response 1.0
/_/ Form 3 Holdings Reported Company Act of 1940 -------------------------------
/_/ Form 4 Transactions Reported
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1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or Trading Symbol 6.Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Rollert Gordon J. ASA International Ltd. (ASAA) _X__Director ____10% Owner
____Officer (give ____Other (specify
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(Last) (First) (Middle) 3. IRS Identification 4. Statement for Month/Year title below)
Number of Reporting below)
Person, if an entity _____________________________
P.O. Box 620130 (Voluntary)
###-##-#### 12/98
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(Street) 5. If Amendment, Date of Original 7. Individual or Joint/Group Reporting
(Month/Year) (check applicable line)
_____ Form Filed by One Reporting Person
_____ Form Filed by More than One
Newton (Lower Falls) MA 02462-0130 Reporting Person
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(City) (State) (Zip) Table I-- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owner
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1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) or 5. Amount of 6. Owner- 7. Nature of
(Instr. 3) action action Disposed of (D) Securities ship Indirect
Date Code (Instr. 3, 4 and 5) Beneficially Form: Beneficial
(Month/ (Instr. 8) Owned at end Direct Ownership
Day/ (A) or of Issuer's (D) or (Instr. 4)
Year) Amount (D) Price Fiscal Year Indirect
(Instr. 3 and 4) (I) (Instr.
4)
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Common Stock (no change) 6,785 shares D
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3,877 shares *I
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* shares are owned by the Estate of Harvey D. Hiller, Mr. Rollert's wife's
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father, pending transfer to Mr. Rollert's wife.
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* If the form is filed by more than one reporting person, see instruction 4(b)(v).
SEC 2270 (7-97)
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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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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of Deri- 6. Date Exercis 7. Title and Amount of Under-
Security (Instr.3) sion of action action tive Securities Ac- able and Expi- lying Securities
Exercise Date Code quired (A) or Dis- ration Date (Instr. 3 and 4)
Price of (Month/ (Instr. 8) posed of (D) (Month/Day/
Deriva- Day/ (Instr. 3, 4, and 5) Year)
tive Year)
Security
Date Expira- Amount or
Exer- tion Number of
(A) (D) cisable Date Title Shares
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Option to Purchase $1.56/sh 9/19/97 I 20,000 7/7/96* 7/6/02* Common 20,000
Stock
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8. Price 9. Number 10. Owner- 11. Nature
of of Deriv- ship of of Indi-
De- ative Deriva- rect
riva- Secur- tive Benefi-
tive ities Secur- cial
Sec- Bene- ity: Di- Owner-
urity ficially rect ship
(Instr. 5) Owned (D) or (Instr. 4)
at End Indir-
of Year ect (I)
(Instr. 4) (Instr. 4)
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1.56 0* D
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Explanation of Responses: Mr. Rollert sold back to ASA for $10,000 his option to purchase 20,000 shares of
Common Stock. The option became fully vested on 7/7/96 and was scheduled to expire on 7/6/02, but
was cancelled on 9/19/97 when repurchased by ASA.
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations. /S/ GORDON J. ROLLERT FEBRUARY 16, 1999
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ** Signature of Reporting Person Date
Gordon J. Rollert
Note: File three copies of this Form, one of which must be manually signed. If space provided 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.
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