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MBOT Microbot Medical Inc

0.9985
0.00 (0.00%)
Pre Market
Last Updated: 10:11:00
Delayed by 15 minutes
Share Name Share Symbol Market Type
Microbot Medical Inc NASDAQ:MBOT NASDAQ Common Stock
  Price Change % Change Share Price Bid Price Offer Price High Price Low Price Open Price Shares Traded Last Trade
  0.00 0.00% 0.9985 0.9398 0.9987 0 10:11:00

Annual Statement of Changes in Beneficial Ownership (5)

18/10/2019 6:40pm

Edgar (US Regulatory)


FORM 5
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

                                                                                  
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response...
1.0                       

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 *

Mona Joseph

2. Issuer Name and Ticker or Trading Symbol

Microbot Medical Inc. [MBOT]

5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                    __X__ 10% Owner
_____ Officer (give title below)    _____ Other (specify below)

(Last)          (First)          (Middle)

808 HAMPTON ST

3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY)
12/31/2018 
(Street)

COLUMBIA, SC 29201

(City)        (State)        (Zip)
4. If Amendment, Date Original Filed(MM/DD/YYYY)

 
6. Individual or Joint/Group Filing(Check Applicable Line)

_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person


Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date2A. Deemed Execution Date, if any3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Amount(A) or (D)Price
Microbot Medical Common Stock 11/19/2018  P5 2400 A$2.99 348971 D  
Microbot Medical Common Stock 11/21/2018  P5 24873 A$2.21 348971 D  
Microbot Medical Common Stock 11/21/2018  S5 6309 A$2.96 348971 D  
Microbot Medical Common Stock 11/26/2018  P5 37986 A$1.95 348971 D  

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares

Explanation of Responses:

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Mona Joseph
808 HAMPTON ST
COLUMBIA, SC 29201

X


Signatures
Joseph Mona10/18/2019
**Signature of Reporting PersonDate

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