Termination of Registration of a Class of Security Under Section 12(b) (15-12b)

UNITED S TA TES

SECURITIES AND EXCHANGE COMMISSION

W ashington, D.C. 20549

 

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FORM 15

 

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CE R TIFIC A TION AND NOTICE OF TERMIN A TION OF REGISTR A TION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934

OR SUSPENSION OF DUTY T O FILE REPO R TS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

 

C o mm i ss i o n F il e N u m b e r 001-34930

 

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ExamWorks Group, Inc.

( E xa c t n a m e o f r e g i s t r a n t a s s p ec i f i e d i n i t s c h a r t er )

 

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3280 Peachtree Road, N.E.

Suite 2625

Atlanta, GA 30305

[phone]

( A ddr e ss , in c ludin g z i p c o d e , a n d t e l e ph o n e nu m b e r , in c ludin g a r e a c o d e , o f r e g i s t r a n t ’ s p r in c ip a l e x ec u t i v e o ff i ce s )

 

C o mm o n S t o c k , $0 . 0 001 p a r va l u e p e r s h a r e

( T i t l e o f e a c h c l a s s o f s ec u r i t i e s c ov e r e d b y t hi s F o r m )

 

N o n e

( T i t l e s o f a l l o t h e r c l a ss e s o f s ec u r i t i e s f o r w hi c h a du t y t o f il e r e p o r t s und e r s ec t i o n 13 ( a ) o r 15 ( d ) r e m a i n s )

 

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Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

 

		Rule 12g-4(a)(1)	☒
		Rule 12g-4(a)(2)	☐
		Rule 12h-3(b)(1)(i)	☒
		Rule 12h-3(b)(1)(ii)	☐
		Rule 15d-6	☐
		Rule 15d-22(b)	☐

 

Approximate number of holders of record as of the certification or notice date: One

 

 

 

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Pursuant to the requirements of the Securities Exchange Act of 1934, ExamWorks Group, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

		ExamWorks Group, Inc.
Date: August 8, 2016	By:	/s/ J. Miguel Fernandez de Castro
		J. Miguel Fernandez de Castro
		Chief Financial Officer and Senior Executive
		Vice President