SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Bock Thomas

(Last) (First) (Middle)
C/O NOTABLE LABS, LTD.
320 HATCH DRIVE

(Street)
FOSTER CITY CA 94404

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/16/2023
3. Issuer Name and Ticker or Trading Symbol
Notable Labs, Ltd. [ NTBL ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Ordinary Shares 0 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (1) 10/05/2030 Ordinary Shares 4,089 $24.17 D
Stock Option (2) 02/18/2031 Ordinary Shares 6,640 $24.17 D
Stock Option (3) 09/26/2031 Ordinary Shares 88,863 $24.64 D
Stock Option (4) 10/14/2031 Ordinary Shares 8,299 $24.17 D
Explanation of Responses:
1. (1) This stock option award was granted October 6, 2020, and vests in equal installments on a monthly basis of a four-year period beginning on September 1, 2020 and ending September 1, 2024, subject to a 1-year cliff, assuming continued employment through the applicable vesting date.
2. (2) This stock option award was granted February 19, 2021 and vested in equal installments on a monthly basis of a three month period beginning on February 19, 2021 and ended May 19, 2021.
3. (3) This stock option award was granted September 27, 2021 and vests in equal installments on a monthly basis of a four-year period beginning on April 30, 2021 and ending April 30, 2025, subject to a 1-year cliff, assuming continued employment through the applicable vesting date.
4. (4) This stock option award was granted on October 15, 2021 and was fully vested on the date of grant.
/s/ Thomas Bock 10/17/2023
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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