SEC Form 3 | |||||||||||||||||||||||||||||||
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE | ||||||||||||||||||||||||||||||
COMMISSION | OMB APPROVAL | ||||||||||||||||||||||||||||||
Washington, D.C. 20549 | |||||||||||||||||||||||||||||||
OMB Number: | 3235- | ||||||||||||||||||||||||||||||
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF | 0104 | ||||||||||||||||||||||||||||||
Estimated average burden | 0.5 | ||||||||||||||||||||||||||||||
SECURITIES | response: | ||||||||||||||||||||||||||||||
hours per | |||||||||||||||||||||||||||||||
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 | |||||||||||||||||||||||||||||||
or Section 30(h) of the Investment Company Act of 1940 | |||||||||||||||||||||||||||||||
1. Name and Address of Reporting Person* | 2. Date of Event | 3. Issuer Name and Ticker or Trading Symbol | |||||||||||||||||||||||||||||
Wenderow Tal Baruch | (Month/Day/Year) | Microbot Medical Inc.[ MBOT ] | |||||||||||||||||||||||||||||
Requiring Statement | |||||||||||||||||||||||||||||||
08/01/2020 | |||||||||||||||||||||||||||||||
(Last) | (First) | (Middle) | 4. Relationship of Reporting Person(s) to | 5. If Amendment, Date of Original | |||||||||||||||||||||||||||
C/O MICROBOT MEDICAL INC. | Issuer | Filed (Month/Day/Year) | |||||||||||||||||||||||||||||
(Check all applicable) | |||||||||||||||||||||||||||||||
25 RECREATION PARK DRIVE, | X | Director | 10% Owner | ||||||||||||||||||||||||||||
6. Individual or Joint/Group Filing | |||||||||||||||||||||||||||||||
Officer (give | Other (specify | ||||||||||||||||||||||||||||||
UNIT 108 | (Check Applicable Line) | ||||||||||||||||||||||||||||||
title below) | below) | X | Form filed by One Reporting | ||||||||||||||||||||||||||||
(Street) | Person | ||||||||||||||||||||||||||||||
02043 | Form filed by More than One | ||||||||||||||||||||||||||||||
HINGHAM MA | Reporting Person | ||||||||||||||||||||||||||||||
(City) | (State) | (Zip) | |||||||||||||||||||||||||||||
Table I - Non-Derivative Securities Beneficially Owned | |||||||||||||||||||||||||||||||
1. Title of Security (Instr. 4) | 2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial | ||||||||||||||||||||||||||||
Beneficially Owned (Instr. | Form: Direct | Ownership (Instr. 5) | |||||||||||||||||||||||||||||
4) | (D) or Indirect | ||||||||||||||||||||||||||||||
(I) (Instr. 5) | |||||||||||||||||||||||||||||||
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 | 3. Title and Amount of Securities | 4. | 5. | 6. Nature of | ||||||||||||||||||||||||||
Expiration Date | Underlying Derivative Security | Conversion | Ownership | Indirect Beneficial | |||||||||||||||||||||||||||
(Month/Day/Year) | (Instr. 4) | or Exercise | Form: | Ownership (Instr. | |||||||||||||||||||||||||||
Price of | Direct (D) | 5) | |||||||||||||||||||||||||||||
Amount | Derivative | or Indirect | |||||||||||||||||||||||||||||
or | Security | (I) (Instr. 5) | |||||||||||||||||||||||||||||
Date | Expiration | Number | |||||||||||||||||||||||||||||
Title | of | ||||||||||||||||||||||||||||||
Exercisable | Date | Shares | |||||||||||||||||||||||||||||
Explanation of Responses: | |||||||||||||||||||||||||||||||
No securities are beneficially owned. | |||||||||||||||||||||||||||||||
/s/ Tal Wenderow | 09/08/2020 | ||||||||||||||||||||||||||||||
** Signature of Reporting | Date |
Person | |
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.
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Microbot Medical Inc. published this content on 09 September 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 10 September 2020 07:54:03 UTC