0001213900-22-056953.txt : 20220919
0001213900-22-056953.hdr.sgml : 20220919
20220919160927
ACCESSION NUMBER: 0001213900-22-056953
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220915
FILED AS OF DATE: 20220919
DATE AS OF CHANGE: 20220919
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kabir Hemi
CENTRAL INDEX KEY: 0001928631
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41375
FILM NUMBER: 221250711
MAIL ADDRESS:
STREET 1: C/O ACTELIS NETWORKS, INC.
STREET 2: 47800 WESTINGHOUSE DRIVE
CITY: FREMONT
STATE: CA
ZIP: 94539
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ACTELIS NETWORKS INC
CENTRAL INDEX KEY: 0001141284
STANDARD INDUSTRIAL CLASSIFICATION: COMMUNICATIONS EQUIPMENT, NEC [3669]
IRS NUMBER: 522160309
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 4039 CLIPPER COURT
CITY: FREMONT
STATE: CA
ZIP: 94538
BUSINESS PHONE: 510-545-1040
MAIL ADDRESS:
STREET 1: 4039 CLIPPER COURT
CITY: FREMONT
STATE: CA
ZIP: 94538
4
1
ownership.xml
X0306
4
2022-09-15
0
0001141284
ACTELIS NETWORKS INC
ASNS
0001928631
Kabir Hemi
4039 CLIPPER COURT
FREMONT
CA
94538
0
1
0
0
Vice President, Operations
Stock Option (Right to Buy)
4.00
2022-09-15
4
A
0
3260
0
A
2032-09-15
Common Stock, $0.0001 par value
3260
3260
D
The first quarter of the options will vest on March 24, 2023 ("Vesting Date"), with the remaining three-fourths of the options vesting over the next 36 months on each monthly anniversary date of the Vesting Date, subject to the Reporting Person remaining continuously employed through the final Vesting Date.
/s/ Hemi Kabir
2022-09-18