SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/16/2023 |
3. Issuer Name and Ticker or Trading Symbol
Notable Labs, Ltd. [ NTBL ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Ordinary Shares | 0 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option | (1) | 10/05/2030 | Ordinary Shares | 4,089 | 24.17 | D | |
Stock Option | (2) | 02/18/2031 | Ordinary Shares | 6,640 | 24.17 | D | |
Stock Option | (3) | 09/26/2031 | Ordinary Shares | 88,863 | 24.64 | D | |
Stock Option | (4) | 10/14/2031 | Ordinary Shares | 8,299 | 24.17 | D |
Explanation of Responses: |
1. (1) This stock option award was granted October 6, 2020, and vests in equal installments on a monthly basis of a four-year period beginning on September 1, 2020 and ending September 1, 2024, subject to a 1-year cliff, assuming continued employment through the applicable vesting date. |
2. (2) This stock option award was granted February 19, 2021 and vested in equal installments on a monthly basis of a three month period beginning on February 19, 2021 and ended May 19, 2021. |
3. (3) This stock option award was granted September 27, 2021 and vests in equal installments on a monthly basis of a four-year period beginning on April 30, 2021 and ending April 30, 2025, subject to a 1-year cliff, assuming continued employment through the applicable vesting date. |
4. (4) This stock option award was granted on October 15, 2021 and was fully vested on the date of grant. |
/s/ Thomas Bock | 10/17/2023 | |
** Signature of Reporting Person | Date | |
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. |