Srinivas Akkaraju - Sep 23, 2021 Form 4 Insider Report for Jiya Acquisition Corp. (JYAC)

Role: Director, 10%+ Owner
Signature: By: /s/ Srinivas Akkaraju, By: Richard Van Doren, attorney-in-fact
Stock symbol: JYAC
Transactions as of: Sep 23, 2021
Transactions value $: $0
Form type: 4
Date filed: 9/27/2021, 04:52 PM
Previous filing: Aug 30, 2021
Next filing: Nov 17, 2021

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Underlying Class	Amount	Exercise Price	Ownership	Footnotes
transaction	JYAC	Class B Common Stock	Other		+30K	+1.25%		2.44M	Sep 23, 2021	Class A Common Stock	30K		See Footnotes	F1, F2, F3, F4
transaction	JYAC	Class B Common Stock	Other		-30K	-1.23%		2.41M	Sep 23, 2021	Class A Common Stock	30K		See Footnotes	F1, F3, F4, F5

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	The shares of Class B Common Stock of the Issuer ("Class B Shares") will automatically convert into shares of Class A Common Stock of the Issuer ("Class A Shares") on a one-for-one basis (subject to certain adjustments for stock splits, stock dividends, reorganizations, recapitalizations and similar transactions) concurrently with or immediately following the consummation of the Issuer's initial business combination, as described in the section entitled "Description of Securities" in the Issuer's Registration Statement on Form S-1 (File No. 333-249808) filed with the Securities and Exchange Commission on November 16, 2020. The Class B Shares have no expiration date.
F2	Reflects the forfeiture of Class B Shares held by a director of the Board of Directors of the Issuer ("Issuer Board") upon such director's resignation from the Issuer Board. As a result, these Class B Shares were automatically returned to Jiya Holding Company LLC ("Jiya Holdco") for no consideration ($0).
F3	Reflects the Class B Shares held by Jiya Holdco. This amount does not reflect the 30,000 Class B shares directly held by Dr. Srinivas Akkaraju M.D., Ph.D.
F4	Jiya HoldCo is wholly owned by Samsara BioCapital, L.P. ("Samsara LP"). Dr. Akkaraju has voting and dispositive control over the reported securities held by Jiya Holdco via Dr. Akkaraju's control of Samsara LP's general partner, Samsara BioCapital GP, LLC. Each of the Reporting Persons disclaims beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein.
F5	Reflects the transfer of 30,000 Class B Shares from Jiya Holdco for no consideration ($0) to a director appointed to the Issuer Board in respect of their service on the Issuer Board. These Class B Shares are subject to forfeiture if the director is removed from office as a director or voluntarily resigns from their position as a member of the Issuer Board at any time before the consummation of the Issuer's initial business combination. Upon any such forfeiture, the Class B Shares will be automatically returned to Jiya Holdco for no consideration ($0).