SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES 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 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 05/24/2013
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3. Issuer Name and Ticker or Trading Symbol
Carlyle GMS Finance, Inc.
[ NONE ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock, par value $0.01 per share (the Common Stock) |
262,051
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D |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
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/s/ Ian J. Sandler - attorney in fact |
06/07/2013 |
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** 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. |
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POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS that AFA Sjukforsakringsaktiebolag (the
"Company") does hereby make, constitute and appoint each of Ian Sandler and Orit
Mizrachi (or any person designated in writing by one of the attorneys-in-fact),
acting individually, its true and lawful attorney, to execute and deliver in its
name and on its behalf, any and all filings required to be made by the Company
under the Securities Exchange Act of 1934, as amended (the "Act"), with respect
to securities of Carlyle GMS Finance, Inc. which may be deemed to be
beneficially owned by the Company under the Act, and to take any other action of
any type whatsoever in connection with the foregoing (including, without
limitation, filing of a Form ID with the Securities and Exchange Commission)
that, in the opinion of such attorney in fact, may be of benefit to, in the best
interest of, or legally required by the Company, it being understood that the
documents executed by such attorney-in-fact on behalf of the Company pursuant to
this Power of Attorney shall be in such form and shall contain such terms and
conditions as such attorney-in-fact may approve in such attorney-in-fact's
discretion, giving and granting unto each said attorney-in-fact power and
authority to act in the premises as fully and to all intents and purposes as the
Company might or could do if personally present by one of its authorized
signatories, hereby ratifying and confirming all that said attorney-in-fact
shall lawfully do or cause to be done by virtue hereof. The Company acknowledges
that the foregoing attorneys-in-fact, in serving in such capacity at the request
of the Company, are not assuming any of the Company's responsibilities to comply
with the Act.
THIS POWER OF ATTORNEY shall remain in full force and effect until revoked in
writing by the Company.
IN WITNESS WHEREOF, the undersigned has duly caused this Power of Attorney to be
executed as of this 5th day of June 2013.
AFA SJUKFORSAKRINGSAKTIEBOLAG
By: /s/ Johan Held
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Name: Johan Held
Title: EVP, Head of Asset Management
By: /s/ Christer Jorneskog
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Name: Christer Jorneskog
Title: Head of Private Equity