Microbot Medical Inc. — Director's Dealing 2016

Nov 30, 2016

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: Microbot Medical Inc. (MBOT)
CIK: 0000883975
Period of Report: 2016-11-28

Reporting Person: ALPHA CAPITAL ANSTALT (10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2016-11-28	Common Stock	J	9753549	$0.00	Acquired	9753549	Direct
2016-11-28	Common Stock	J	7977092	$0.00	Disposed	1776457	Direct

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2016-11-28	Convertible Debenture	$0.64	J	1776457	Acquired		Common Stock ()	Direct

Footnotes

F1: Pursuant to a merger agreement effective as of November 28, 2016 reported in a Form 8-K filed by the Issuer on November 29, 2016, Alpha Capital Anstalt ("Alpha") was issued 9,753,549 shares of common stock, which immediately following the merger were surrendered by Alpha to the Issuer pursuant to the terms of a Right to Shares Agreement. The Right to Shares Agreement contains a 4.99% "blocker" provision designed to prevent Alpha from being a beneficial owner of more than 4.99% of the Issuer's Common Stock. Therefore, Alpha is no longer an affiliate of the Issuer.

F2: In connection with the merger on November 28, 2016, Alpha exchanged a non-convertible note for a convertible debenture containing a 4.99% "blocker" provision.

F3: The number of shares owned by Alpha does not include any shares issued to Lane Ventures, Inc., a consultant of the Issuer. Alpha disclaims beneficial ownership of any of the shares issued to Lane Ventures, Inc.