FORM 3 OMB APPROVAL
OMB NUMBER 3235-0104
Expires: December 31, 2001
Estimated Average burden
hours per response.....0.5
U.S. 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, Section
17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the
Investment Company Act of 1940
1. Name and Address of Reporting Person*
GIN99, LLC
c/o Clifford Chance Rogers & Wells LLP
200 Park Avenue
New York, New York 10166
2. Date of Event Requiring Statement (Month/Day/Year)
03/07/00
3. IRS or Social Security Number of Reporting Person (Voluntary)
N/A
4. Issuer Name and Ticker or Trading Symbol
Avitar, Inc. (AMEX: AVR)
5. Relationship of Reporting Person to Issuer (Check all applicable)
|_| Director |X| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
|_| Form filed by One Reporting Person
|X| Form filed by More than One Person
- --------------------------------------------------------------------------------
TABLE I - NON DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of Security (Instr. 4)
No Securities Owned
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)
- --------------------------------------------------------------------------------
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).
Page 1 of 9
<PAGE>
- --------------------------------------------------------------------------------
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of Derivative Security (Instr. 4)
No securities owned
(i) Series B Preferred Stock
(ii) Series B Preferred Stock
(iii) Series B Preferred Stock
(iv) Warrants to purchase common stock
(v) Warrants to purchase common stock
(vi) Warrants to purchase common stock
2. Date Exercisable and Expiration Date (Month/Day/Year)
(i) At any time / no expiration date
(ii) At any time / no expiration date
(iii) At any time / no expiration date
(iv) At any time / expire 11/09/01
(v) At any time / expire 11/09/01
(vi) At any time / expire 11/09/01
3. Title and Amount of Securities Underlying Derivative Security (Instr.4)
(i) Common stock; 7,364,500 shares
(ii) Common stock; 7,364,500 shares
(iii) Common stock; 7,364,500 shares
(iv) Common stock; 2,400,000 shares
(v) Common stock; 2,400,000 shares
(vi) Common stock; 2,400,000 shares
4. Conversion or Exercise Price of Derivative Security
(i) 10 shares of common stock
(ii) 10 shares of common stock
(iii) 10 shares of common stock
(iv) $0.25 per share
(v) $0.25 per share
(vi) $0.25 per share
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
(i) D
(ii) I
(iii) I
(iv) D
(v) I
(vi) I
Page 2 of 9
<PAGE>
6. Nature of Indirect Beneficial Ownership (Instr. 5)
(i) (1)
(ii) (2)
(iii) (1)
(iv) (2)
- --------------------------------------------------------------------------------
Explanation of Responses:
(1) Beneficially owned by Lighthouse Capital Insurance Company, due to its
100% ownership interest in each of E-Commerce Investments Ltd., E-Links
Investments Ltd., E-Sales Investments Ltd., E-Trade Investments Ltd. and
E-Business Investments Ltd., each of which owns 20% of the membership interests
of GIN99, LLC.
(2) Beneficially owned by E-Commerce Investments Ltd., E-Links Investments
Ltd., E-Sales Investments Ltd., E-Trade Investments Ltd. and E-Business
Investments Ltd., each of which owns 20% of the membership interests of GIN99,
LLC.
/s/ Joseph Rotella 3/17/00
---------------------------------- -------
** Signature of Reporting Persons Date
** Intentional misstatements or omission 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.
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 3 of 9
<PAGE>
Joint Filer Information
Name: Lighthouse Capital Insurance Company
Address: Anderson Square
Georgetown
Grand Cayman
Cayman Islands
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Peter Jones
Name:Peter Jones
Title: Secretary
Page 4 of 9
<PAGE>
Joint Filer Information
Name: E-Commerce Investments Ltd.
Address: c/o Leopold Joseph (Bahamas) Limited
Third Floor, Euro Canadian Centre
Marlborough Street
Nassau, Bahamas
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Ivylyn Cassar
Name: Ivylyn Cassar
Title: Director - Ibis S.A.
Page 5 of 9
<PAGE>
Joint Filer Information
Name: E-Links Investments Ltd.
Address: c/o Leopold Joseph (Bahamas) Limited
Third Floor, Euro Canadian Centre
Marlborough Street
Nassau, Bahamas
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Ivylyn Cassar
Name: Ivylyn Cassar
Title: Director - Ibis S.A.
Page 6 of 9
<PAGE>
Joint Filer Information
Name: E-Sales Investments Ltd.
Address: c/o Leopold Joseph (Bahamas) Limited
Third Floor, Euro Canadian Centre
Marlborough Street
Nassau, Bahamas
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Ivylyn Cassar
Name: Ivylyn Cassar
Title: Director - Ibis S.A.
Page 7 of 9
<PAGE>
Joint Filer Information
Name: E-Trade Investments Ltd.
Address: c/o Leopold Joseph (Bahamas) Limited
Third Floor, Euro Canadian Centre
Marlborough Street
Nassau, Bahamas
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Ivylyn Cassar
Name: Ivylyn Cassar
Title: Director - Ibis S.A.
Page 8 of 9
<PAGE>
Joint Filer Information
Name: E-Business Investments Ltd.
Address: c/o Leopold Joseph (Bahamas) Limited
Third Floor, Euro Canadian Centre
Marlborough Street
Nassau, Bahamas
Designated Filer: GIN99, LLC
Issuer and Ticker Symbol: Avitar, Inc. (AMEX: AVR)
Date of Event Requiring Statement: 03/07/00
Signature: By: /s/ Ivylyn Cassar
Name: Ivylyn Cassar
Title: Director - Ibis S.A.
Page 9 of 9
