Microbot Medical Inc. — Director's Dealing 2016

Nov 30, 2016

SEC Form 3 — Initial Statement of Beneficial Ownership

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

Reporting Person: Gadot Harel (Director, Chairman and CEO, 10% Owner)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock, par value $0.01 per share	2652704	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Stock Option (Right to Buy)	$	2024-09-01	Common Stock, par value $0.01 per share (1167960)		Indirect

Footnotes

F1: Mr. Gadot is the Chief Executive Officer, Company Group Chairman and majority equity owner of MEDX Venture Group and thus may be deemed to share voting and investment power over the shares beneficially owned by this entity.

F2: The exercise price of such options were to be determined pursuant to an independent valuation of the underlying shares on the date of grant, which valuation has not yet been obtained. The options were originally granted by Microbot Medical Ltd., a wholly-owned subsidiary of the Issuer ("Microbot"), to the Reporting Person in September 2014 and the underlying securities were the ordinary shares of Microbot. (Footnote continues in footnote (3)).

F3: On November 28, 2016, the Issuer assumed such options as part of its acquisition of Microbot. Upon the determination of the exercise price, the Reporting Person will amend this Form 3 accordingly.