ACTELIS NETWORKS INC — Director's Dealing 2022

May 17, 2022

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: ACTELIS NETWORKS INC (ASNS)
CIK: 0001141284
Period of Report: 2022-05-12

Reporting Person: Niv Israel (Director)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	597944	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Option	$0.0644	2025-06-30	Common Stock (70109)		Direct

Footnotes

F1: Consists of (i) 458,557 shares of common stock held by The Niv Family Trust, for which the Reporting Person and his spouse serve as trustees, (ii) 139,387 shares of common stock held by Sharon Hava Niv 2015 Family Trust for which the Reporting Person and his spouse serve as trustees. The Reporting Person may be deemed to have beneficial ownership of the shares held by the aforementioned entities.

F2: This Option grant vested in full on 06/29/2019.