# EDGAR Filing Document

**Accession Number:** 0001222287
**File Stem:** 0001222287-26-000002
**Filing Date:** 2026-1
**Character Count:** 14821
**Document Hash:** 45c4d07576447774bc66926729f09a47
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001222287-26-000002.hdr.sgml**: 20260128

**ACCESSION NUMBER**: 0001222287-26-000002

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20260128

**FILED AS OF DATE**: 20260128

**DATE AS OF CHANGE**: 20260128

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** BOTHA ROELOF
- **CENTRAL INDEX KEY:** 0001222287

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-43065
- **FILM NUMBER:** 26574203

**MAIL ADDRESS:**
- **STREET 1:** C/O SEQUOIA CAPITAL
- **STREET 2:** 2800 SAND HILL RD, SUITE 101
- **CITY:** MENLO PARK
- **STATE:** CA
- **ZIP:** 94025
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Ethos Technologies Inc.
- **CENTRAL INDEX KEY:** 0001788451
- **STANDARD INDUSTRIAL CLASSIFICATION:** INSURANCE AGENTS BROKERS & SERVICES [6411]
- **ORGANIZATION NAME:** 02 Finance
- **EIN:** 813181024
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 1606 HEADWAY CIRCLE
- **STREET 2:** #9013
- **CITY:** AUSTIN
- **STATE:** TX
- **ZIP:** 78754
- **BUSINESS PHONE:** (415) 915-0665

**MAIL ADDRESS:**
- **STREET 1:** 1606 HEADWAY CIRCLE
- **STREET 2:** #9013
- **CITY:** AUSTIN
- **STATE:** TX
- **ZIP:** 78754

## Exhibit 24.1

------

LIMITED POWER OF ATTORNEY<br>FOR CERTAIN FILINGS WITH THE

SECURITIES AND EXCHANGE COMMISSION

Know all by these presents that the undersigned hereby constitutes and appoints each of Marie Klemchuk and Jung Yeon Son the undersigned's true and lawful attorney-in-fact to:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(1) Execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director and/or stockholder of any entity affiliated with Sequoia Capital Operations, LLC or any corporation or other person in which an investment fund affiliated with Sequoia Capital Operations, LLC makes an investment (each, a "Company"), Forms 3, 4, and 5 and amendments thereto in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended (the "1934 Act"), and the rules thereunder, as well as any reports on Schedules 13D or 13G or Forms 13F or 13H and amendments thereto in each case in accordance with Section 13 of the 1934 Act and the rules thereunder or any Forms 144 in accordance with Rule 144 under the Securities Act of 1933, as amended (the "1933 Act");

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(2) Do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, Schedule 13D, Schedule 13G, Form 13F, Form 13H or Form 144 or amendment thereto and timely file such form with the United States Securities and Exchange Commission (the "SEC") and any stock exchange or similar authority; and

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(3) Take any other action of any type whatsoever which, in the opinion of such attorney-in-fact, may be necessary or desirable in connection with the foregoing authority, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Limited Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve.

The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever required, 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 the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that each such attorney-in-fact, or any such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this Limited Power of Attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is any Company assuming, any of the undersigned's responsibilities to comply with Section 13 or Section 16 of the 1934 Act or Rule 144 under the 1933 Act.

This Limited Power of Attorney shall remain in full force and effect until revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. This Limited Power of Attorney may be filed with the SEC as a confirming statement of the authority granted herein.

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[Signature Page Follows]

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IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to be executed as of this 28th day of January, 2026.

By: <u>/s/ Roelof Botha</u><br> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Roelof Botha<br>

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### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>BOTHA ROELOF<br><sub>(Last) (First) (Middle)</sub><br>2800 SAND HILL ROAD, SUITE 101<br><sub>(Street)</sub><br>MENLO PARK, CA 94025<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>Ethos Technologies Inc. [ LIFE ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2026-01-28 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director   [X] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<br>_ _ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 63370 | <sup>(1)</sup> | I | Nalrena, L.L.C<sup>(4)</sup> |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 79246 | <sup>(1)</sup> | I | Spelunker Channel Holdings, LLC<sup>(4)</sup> |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 1897656 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Fund XV, L.P.<sup>(3)</sup> |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 79975 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 28725 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Series A-2 Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 291875 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Series A Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 4767653 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Fund XV, L.P.<sup>(3)</sup> |
| Series A Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 200936 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Series A Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 72174 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Series A Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 733307 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 1124709 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Fund XV, L.P.<sup>(3)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 47400 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 17025 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 172989 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Series C Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 180988 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Fund XV, L.P.<sup>(3)</sup> |
| Series C Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 7627 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Series C Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 2739 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Series C Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 27837 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Series C Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 1917944 | <sup>(1)</sup> | I | Sequoia Capital U.S. Growth Fund VIII, L.P.<sup>(3)</sup> |
| Series D Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 56275 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Fund XV, L.P.<sup>(3)</sup> |
| Series D Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 2058 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P.<sup>(3)</sup> |
| Series D Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 878 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture Partners Fund XV, L.P.<sup>(3)</sup> |
| Series D Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 12274 | <sup>(1)</sup> | I | Sequoia Capital U.S. Venture XV Principals Fund, L.P.<sup>(3)</sup> |
| Series D Preferred Stock | <sup>(1)</sup> | <sup>(2)</sup> | Class A Common Stock | 214464 | <sup>(1)</sup> | I | Sequoia Capital U.S. Growth Fund VIII, L.P.<sup>(3)</sup> |

---

### Footnotes:

(1) The Series A-2, Series A, Series B, Series C, and Series D Preferred Stock are each convertible into Class A Common Stock on a ratio dependent on the public offering price of the Class A Common Stock in the Issuer's initial public offering (IPO).  Upon the closing of the Issuer's IPO, all shares of Series A-2, Series A, Series B, Series C, and Series D Preferred Stock will be automatically converted into shares of Class A Common Stock of the Issuer (the "Class A Conversion").  Immediately following the Class A Conversion, each share of the Class A Common Stock shall be exchanged at a 1:1 ratio for shares of Class B Common Stock. Each share of Class B Common Stock is convertible at the option of the holder thereof into one share of Class A Common Stock and otherwise in accordance with the terms of the Issuer's Certificate of Incorporation.

(2) Each share of the Series A-2, Series A, Series B, Series C, and Series D Preferred Stock has no expiration date.

(3) The Reporting Person is a director and stockholder of SC US (TTGP), Ltd. SC US (TTGP), Ltd. is (i) the general partner of SC U.S. Growth VIII Management, L.P., which is the general partner of Sequoia Capital U.S. Growth Fund VIII, L.P. (GFVIII), and (ii) the general partner of SC U.S. Venture XV Management, L.P., which is the general partner of Sequoia Capital U.S. Venture Fund XV, L.P., Sequoia Capital U.S. Venture Partners Fund XV (Q), L.P., Sequoia Capital U.S. Venture Partners Fund XV, L.P., and Sequoia Capital U.S. Venture XV Principals Fund, L.P. (collectively, the XV Funds).  The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed to be an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.

(4) The Reporting Person is a director and stockholder of SC US SSF 2013 (TTGP), L.L.C. SC US SSF 2013 (TTGP), L.L.C. is the general partner of SC U.S. Scout Seed Fund 2013 Management, L.P., which is the general partner of Sequoia Capital U.S. Scout Seed Fund 2013, L.P., which wholly owns Sequoia Capital U.S. Scout Fund IV, L.L.C., which in turn wholly owns Nalrena, L.L.C. and Spelunker Channel Holdings, LLC (collectively, the Scout Funds). The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed to be an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.

**Signature:** /s/ Jung Yeon Son, Attorney-in-fact for Roelof Botha  
**Date:** 2026-01-28

### Remarks:

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 4 (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.**