0001213900-22-056956.txt : 20220919
0001213900-22-056956.hdr.sgml : 20220919
20220919161050
ACCESSION NUMBER: 0001213900-22-056956
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: Ruderman Jan
CENTRAL INDEX KEY: 0001927476
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-41375
FILM NUMBER: 221250724
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
0001927476
Ruderman Jan
4039 CLIPPER COURT
FREMONT
CA
94538
0
1
0
0
CRO-Americas
Stock Option (Right to Buy)
4.00
2022-09-15
4
A
0
21739
0
A
2032-09-15
Common Stock, $0.0001 par value
21739
21739
D
The first quarter of the options will vest on December 21, 2022 ("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/ Jan Ruderman
2022-09-18