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)
10/01/2009
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3. Issuer Name and Ticker or Trading Symbol
Fidelity National Information Services, Inc.
[ FIS ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| President and CEO |
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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)
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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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| Common Stock |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 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: |
|
|
/s/ Stacey A. Lombardi, as Attorney-in-Fact |
10/05/2009 |
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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 FOR SEC REPORTING OBLIGATIONS
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned hereby
makes, constitutes and appoints Ronald D. Cook, Charles H. Keller, Stacey
A. Lombardi and Andrea Gerhart as the undersigned's true and lawful
attorneys-in-fact, with full power and authority as hereinafter described
on behalf of and in the name, place and stead of the undersigned to:
(1) prepare, execute, acknowledge, deliver and file a Form ID
(including any amendments or authentications thereto) with respect to
obtaining EDGAR codes, with the U.S. Securities and Exchange Commission;
(2) prepare, execute, acknowledge, deliver and file Forms 3,
4 and 5 (including any amendments thereto) with respect to the securities
of Fidelity National Information Services, Inc., a Georgia corporation
(the "Company"), with the U.S. Securities and Exchange Commission,
any national securities exchanges and the Company, as considered
necessary or advisable under Section 16(a) of the Securities Exchange
Act of 1934 and the rules and regulations promulgated thereunder, as
amended from time to time (the "Exchange Act");
(3) seek or obtain, as the undersigned's representative
and on the undersigned's behalf, information on transactions in the
Company's securities from any third party, including brokers, employee
benefit plan administrators and trustees, and the undersigned hereby
authorizes any such person to release any such information to the
undersigned and approves and ratifies any such release of information;
and
(4) perform any and all other acts which in the discretion
of such attorneys-in-fact are necessary or desirable for and on behalf
of the undersigned in connection with the foregoing.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require,
such attorneys-in-fact to act in their discretion on information provided
to such attorneys-in-fact without independent verification of such
information;
(2) any documents prepared and/or executed by such
attorneys-in-fact on behalf of the undersigned pursuant to this Power of
Attorney will be in such form and will contain such information and
disclosure as such attorney-in-fact, in his or her discretion, deems
necessary or desirable;
(3) neither the Company nor such attorneys-in-fact assumes
(i) any liability for the undersigned's responsibility to comply with
the requirements of the Exchange Act, (ii) any liability of the undersigned
for any failure to comply with such requirements, or (iii) any obligation
or liability of the undersigned for profit disgorgement under Section 16(b)
of the Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under the
Exchange Act, including without limitation the reporting requirements under
Section 16 of the Exchange Act.
The undersigned hereby gives and grants the foregoing
attorneys-in-fact full power and authority to do and perform all and every
act and thing whatsoever requisite, necessary or appropriate to be done in
and about the foregoing matters as fully to all intents and purposes as the
undersigned might or could do if present, with full power of substitution
and revocation, hereby ratifying all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, of, for and on behalf of the
undersigned, shall lawfully do or cause to be done by virtue of this Power
of Attorney.
This Power of Attorney shall remain in full force and effect until
revoked by the undersigned in a signed writing delivered to such
attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of this 24th day of September, 2009.
/s/ Frank R. Martire
Frank R. Martire
