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)
01/22/2018
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3. Issuer Name and Ticker or Trading Symbol
MGIC INVESTMENT CORP
[ MTG ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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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 |
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| 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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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: |
| Remarks: |
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| No securities are beneficially owned. |
|
Dan D. Stilwell, Attorney-in-Fact |
01/24/2018 |
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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. |
Limited Power of Attorney
KNOW ALL BY THESE PRESENTS, that the undersigned is required,
or may be required in the future, to file reports of changes
in beneficial ownership of equity securities of MGIC Investment
Corporation (the "Company").
To facilitate the filing of these reports, the undersigned
hereby appoints each person who is the Chief Financial Officer,
the General Counsel, the Associate General Counsel, any
Assistant General Counsel, the Secretary, or any Assistant
Secretary of the Company as the undersigned's attorney-in-fact
and agent to: (i)apply on behalf of the undersigned (if necessary)
for access to the EDGAR System maintained by Securities and
Exchange Commission, (ii) apply on behalf of the undersigned for
access codes (if necessary) for the EDGAR System, and (iii) sign
on behalf of the undersigned any Form 3, Form 4, or Form 5 to be
filed by the undersigned with the SEC or any securities exchange.
Each of the persons authorized to act as such attorney-in-fact
and agent above may do so separately without the concurrence of
the other persons. The authority granted hereunder is granted
to the person occupying the position specified at the time such
authority is exercised.
Dated: November 27, 2017
Signature: (S) Melissa Lora
Please print name: Melissa Lora
