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)
01/03/2005
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3. Issuer Name and Ticker or Trading Symbol
POLO RALPH LAUREN CORP
[ RL ]
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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) |
| Senior Vice President and CFO |
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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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| No securities beneficially owned |
0 |
D |
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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 |
| Explanation of Responses: |
|
/s/ Tracey T. Travis |
01/07/2005 |
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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. |
EXHIBIT 24.1
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POWER OF ATTORNEY
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KNOW EVERYONE BY THESE PRESENTS, that I, Tracey T. Travis, hereby make,
constitute and appoint Mr. Edward W. Scheuermann, with full power of
substitution, my true and lawful agent and attorney-in-fact and confer upon
such agent and attorney-in-fact the power and authority, in my name, place and
stead, in any way which I could do if personally present:
(1) to execute for and on my behalf, in my capacity as an officer,
director, and/or stockholder of Polo Ralph Lauren Corporation (the
"Company"), any and all forms and filings required pursuant to Section
16(a) of the Securities Exchange Act of 1934, as amended, and the rules
thereunder, including, without limitation, Forms 3, 4 and 5;
(2) to do and perform any and all acts for and on my behalf (in any of the
capacities described in paragraph (1) above)) which may be necessary or
desirable to complete and execute any such forms or filings and timely
file such forms or filings with the United States Securities and
Exchange Commission and any stock exchange or similar authority; and
(3) to execute and deliver on my behalf (in any of the capacities described
in paragraph (1) above) any other forms, filings, consents,
authorizations, certificates, instruments or other documents necessary
or desirable to authorize, approve, effect, facilitate or consummate
any of the transactions described above.
IN WITNESS WHEREOF, I have hereunto set my hand on this 7th day of January,
2005.
/s/ Tracey T. Travis
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Tracey T. Travis
