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 Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O FORRESTER RESEARCH |
| 400 TECHNOLOGY SQUARE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
09/20/2004
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3. Issuer Name and Ticker or Trading Symbol
FORRESTER RESEARCH INC
[ FORR ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| President, Forrester Asia |
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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)
|
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 |
| Incentive Stock Option (right to buy) |
09/20/2005
|
09/19/2014 |
Common Stock |
23,492 |
17.03 |
D |
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| Non-Qualified Stock Option (right to buy) |
09/20/2005
|
09/19/2014 |
Common Stock |
51,508 |
17.03 |
D |
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| Explanation of Responses: |
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| Remarks: |
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|
Kimberly Maxwell for Charles Chang |
09/22/2004 |
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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. |
POWER OF ATTORNEY*
I hereby constitute and appoint each of Kimberly
Maxwell and Gail Mann signing singly, my true and lawful attorney-in-fact
to:
(1) execute for and on my behalf, in my capacity as an officer and/or
director of Forrester Research, Inc. (the "Company"), Forms 3, 4 and 5 in
accordance with Section 16(a) of the Securities Exchange Act of 1934 and
the rules thereunder;
(2) do and perform any and all acts for and on my
behalf that may be necessary or desirable to complete and execute any such
Form 3, 4 or 5 and timely file such form with the United States Securities
and Exchange Commission and any stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be to my
benefit, in my best interest, or that I am legally required to do, it being
understood that the documents executed by such attorney-in-fact on my
behalf 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.
I hereby grant to each such
attorney-in-fact full power and authority to do and perform any and every
act and thing whatsoever requisite, necessary, or proper to be done in the
exercise of any of the rights and powers herein granted, as fully to all
intents and purposes as I might or could do if personally present, with
full power of substitution or revocation, hereby ratifying and confirming
all that such attorney-in-fact, or such attorney-in-fact's substitute or
substitutes, shall lawfully do or cause to be done by virtue of this power
of attorney and the rights and powers herein granted. I acknowledge that
the attorneys-in-fact, in serving in such capacity at my request, are not
assuming, nor is the Company assuming, any of my responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.
This Power of
Attorney shall remain in full force and effect until I am no longer
required to file Forms 3, 4 and 5 with respect to my holdings of and
transactions in Company securities, unless I earlier revoke it in a signed
writing delivered to the attorneys-in-fact.
IN WITNESS WHEREOF, I have
caused this Power of Attorney to be executed as of this 14th day of
September, 2004.
/s/ Charles Chang
Signature
Charles Chang
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