0001213900-23-041172.txt : 20230518 0001213900-23-041172.hdr.sgml : 20230518 20230518160540 ACCESSION NUMBER: 0001213900-23-041172 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230517 FILED AS OF DATE: 20230518 DATE AS OF CHANGE: 20230518 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Niv Israel CENTRAL INDEX KEY: 0001928580 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41375 FILM NUMBER: 23936066 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 X0407 4 2023-05-17 0 0001141284 ACTELIS NETWORKS INC ASNS 0001928580 Niv Israel 4039 CLIPPER COURT FREMONT CA 94538 1 0 0 0 0 Common stock, par value $0.0001 2023-05-17 4 S 0 422 3.32 D 67218 D The sale reported on this Form 4 represents shares sold by the Reporting Person to cover tax withholding obligations in connection with the vesting and settlement of Restricted Stock Units ("RSUs"). The sale is mandated by the Issuer's election to require the satisfaction of tax withholding obligations to be funded by a "sell to cover" transaction and does not represent a discretionary transaction by the Reporting Person. /s/ Israel Niv 2023-05-18