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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1. Name and Address of Reporting Person* Mayfield XIII, a Cayman Islands Exempted Limited Partnership (Last) (First) (Middle) 2484 SAND HILL ROAD (Street) MENLO PARK CA 94025 (City) (State) (Zip)	2. Date of Event Requiring Statement (Month/Day/Year) 07/21/2021	3. Issuer Name and Ticker or Trading Symbol Couchbase, Inc. [ BASE ]
		4. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner Officer (give title below) Other (specify below)	5. If Amendment, Date of Original Filed (Month/Day/Year)
			6. Individual or Joint/Group Filing (Check Applicable Line) Form filed by One Reporting Person X Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	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)
Common Stock	90,045	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Series B Preferred Stock	(2)	(2)	Common Stock	1,909,090	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)
Series C Preferred Stock	(2)	(2)	Common Stock	715,278	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)
Series D Preferred Stock	(2)	(2)	Common Stock	258,017	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)
Series E Preferred Stock	(3)	(3)	Common Stock	127,014	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)
Series F Preferred Stock	(2)	(2)	Common Stock	169,212	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)
Series G Preferred Stock	(4)	(4)	Common Stock	72,824	0.00	I	Mayfield XIII, a Cayman Islands Exempted Limited Partnership(1)

1. Name and Address of Reporting Person* Mayfield XIII, a Cayman Islands Exempted Limited Partnership (Last) (First) (Middle) 2484 SAND HILL ROAD (Street) MENLO PARK CA 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* Mayfield XIII Management (EGP), L.P., a Cayman Islands Exempted Limited Partnership (Last) (First) (Middle) C/O MAYFIELD, 2484 SAND HILL ROAD (Street) MENLO PARK 94025 (City) (State) (Zip)

1. Name and Address of Reporting Person* Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Co. (Last) (First) (Middle) C/O MAYFIELD, 2484 SAND HILL ROAD (Street) MENLO PARK CA 94025 (City) (State) (Zip)

Explanation of Responses:

1. These shares are held of record by Mayfield XIII, a Cayman Islands Exempted Limited Partnership, or MF XIII. Mayfield XIII Management (UGP), Ltd., a Cayman Islands Exempted Company, or MF XIII UGP, is the general partner of Mayfield XIII Management (EGP), L.P., a Cayman Islands Exempted Limited Partnership, which is the general partner of MF XIII. Rajeev Batra, Navin Chaddha and Vaneeta Varma are the directors of MF XIII UGP. As a result, each of the foregoing entities and individuals may be deemed to share beneficial ownership of the shares owned by MF XIII, but each such entity or person disclaims such beneficial ownership except to the extent of its or their pecuniary interest therein.

2. Immediately prior to the completion of the Issuer's initial public offering, each share of Series B Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series F Preferred Stock is convertible into shares of the Issuer's Common Stock on a one-for-one basis and has no expiration date.

3. Immediately prior to the completion of the Issuer's initial public offering, each share of Series E Preferred Stock is convertible into shares of the Issuer's Common Stock on a 1.05279880234039-for-one basis and has no expiration date.

4. Immediately prior to the completion of the Issuer's initial public offering, each share of Series G Preferred Stock is convertible into shares of the Issuer's Common Stock on a an expected 1.06673317089756-for-one basis and has no expiration date.

Remarks:

	Mayfield XIII, a Cayman Islands Exempted Limited Partnership, By: Mayfield XIII Management (EGP), L.P., its general partner, By: Mayfield XIII Management (UGP), Ltd., its general partner, /s/ Paul Kohli, Authorized Signatory	07/21/2021
	Mayfield XIII Management (EGP), L.P., By: Mayfield XIII Management (UGP), Ltd., its general partner, /s/ Paul Kohli, Authorized Signatory	07/21/2021
	Mayfield XIII Management (UGP), Ltd., /s/ Paul Kohli, Authorized Signatory	07/21/2021
	** Signature of Reporting Person	Date
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