<SEC-DOCUMENT>0001140361-16-088268.txt : 20161130
<SEC-HEADER>0001140361-16-088268.hdr.sgml : 20161130
<ACCEPTANCE-DATETIME>20161130170143
ACCESSION NUMBER:		0001140361-16-088268
CONFORMED SUBMISSION TYPE:	3
PUBLIC DOCUMENT COUNT:		1
CONFORMED PERIOD OF REPORT:	20161128
FILED AS OF DATE:		20161130
DATE AS OF CHANGE:		20161130

ISSUER:		

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			Microbot Medical Inc.
		CENTRAL INDEX KEY:			0000883975
		STANDARD INDUSTRIAL CLASSIFICATION:	BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
		IRS NUMBER:				943078125
		STATE OF INCORPORATION:			DE
		FISCAL YEAR END:			1231

	BUSINESS ADDRESS:	
		STREET 1:		175 DERBY ST. 27/1
		STREET 2:		.
		CITY:			HINGHAM
		STATE:			MA
		ZIP:			02043
		BUSINESS PHONE:		908-938-5561

	MAIL ADDRESS:	
		STREET 1:		175 DERBY ST. 27/1
		STREET 2:		.
		CITY:			HINGHAM
		STATE:			MA
		ZIP:			02043

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	STEMCELLS INC
		DATE OF NAME CHANGE:	20000524

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	CYTOTHERAPEUTICS INC/DE
		DATE OF NAME CHANGE:	19930328

REPORTING-OWNER:	

	OWNER DATA:	
		COMPANY CONFORMED NAME:			Gadot Harel
		CENTRAL INDEX KEY:			0001690103

	FILING VALUES:
		FORM TYPE:		3
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	000-19871
		FILM NUMBER:		162025837

	MAIL ADDRESS:	
		STREET 1:		5 VILLAGE LANE
		CITY:			HINGHAM
		STATE:			MA
		ZIP:			02043
</SEC-HEADER>
<DOCUMENT>
<TYPE>3
<SEQUENCE>1
<FILENAME>doc1.xml
<DESCRIPTION>FORM 3
<TEXT>
<XML>
<?xml version="1.0"?>
<ownershipDocument>

    <schemaVersion>X0206</schemaVersion>

    <documentType>3</documentType>

    <periodOfReport>2016-11-28</periodOfReport>

    <noSecuritiesOwned>0</noSecuritiesOwned>

    <issuer>
        <issuerCik>0000883975</issuerCik>
        <issuerName>Microbot Medical Inc.</issuerName>
        <issuerTradingSymbol>MBOT</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001690103</rptOwnerCik>
            <rptOwnerName>Gadot Harel</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O MICROBOT MEDICAL INC.</rptOwnerStreet1>
            <rptOwnerStreet2>5 HAMADA STREET</rptOwnerStreet2>
            <rptOwnerCity>YOKNEAM</rptOwnerCity>
            <rptOwnerState>L3</rptOwnerState>
            <rptOwnerZipCode>20692</rptOwnerZipCode>
            <rptOwnerStateDescription>ISRAEL</rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>1</isDirector>
            <isOfficer>1</isOfficer>
            <isTenPercentOwner>1</isTenPercentOwner>
            <isOther>0</isOther>
            <officerTitle>Chairman and CEO</officerTitle>
            <otherText></otherText>
        </reportingOwnerRelationship>
    </reportingOwner>

    <nonDerivativeTable>
        <nonDerivativeHolding>
            <securityTitle>
                <value>Common Stock, par value $0.01 per share</value>
            </securityTitle>
            <postTransactionAmounts>
                <sharesOwnedFollowingTransaction>
                    <value>2652704</value>
                </sharesOwnedFollowingTransaction>
            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>I</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value>By MEDX Ventures Group, LLC</value>
                    <footnoteId id="F1"/>
                </natureOfOwnership>
            </ownershipNature>
        </nonDerivativeHolding>
    </nonDerivativeTable>

    <derivativeTable>
        <derivativeHolding>
            <securityTitle>
                <value>Stock Option (Right to Buy)</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <footnoteId id="F2"/>
                <footnoteId id="F3"/>
            </conversionOrExercisePrice>
            <exerciseDate>
                <value>2016-11-28</value>
            </exerciseDate>
            <expirationDate>
                <value>2024-09-01</value>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Common Stock, par value $0.01 per share</value>
                </underlyingSecurityTitle>
                <underlyingSecurityShares>
                    <value>1167960</value>
                </underlyingSecurityShares>
            </underlyingSecurity>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>I</value>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value>By MEDX Ventures Group, LLC (1)</value>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeHolding>
    </derivativeTable>

    <footnotes>
        <footnote id="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.</footnote>
        <footnote id="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 (&quot;Microbot&quot;), to the Reporting Person in September 2014 and the underlying securities were the ordinary shares of Microbot. (Footnote continues in footnote (3)).</footnote>
        <footnote id="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.</footnote>
    </footnotes>

    <ownerSignature>
        <signatureName>/s/ Harel Gadot</signatureName>
        <signatureDate>2016-11-30</signatureDate>
    </ownerSignature>
</ownershipDocument>
</XML>
</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
