Israel Niv - May 12, 2022 Form 3 Insider Report for ACTELIS NETWORKS INC (ASNS)

Role
Director
Signature
/s/ Israel Niv
Stock symbol
ASNS
Transactions as of
May 12, 2022
Transactions value $
$0
Form type
3
Date filed
5/17/2022, 05:36 PM
Next filing
Sep 19, 2022

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding ASNS Common Stock 598K May 12, 2022 See Footnote F1

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding ASNS Option May 12, 2022 Common Stock 70.1K $0.06 Direct F2
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
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.