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*
le Bourgeois Benoit

(Last) (First) (Middle)
C/O ATLIS MOTOR VEHICLES, INC.
1828 N HIGLEY RD., SUITE 116

(Street)
MESA AZ 85205

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/27/2022
3. Issuer Name and Ticker or Trading Symbol
Atlis Motor Vehicles Inc [ AMV ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP of User Experience
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)
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 Options (Right to Buy) (1) 08/24/2031 Class A Common Stock 126,007 $7 D
Stock Options (Right to Buy) (2) 08/24/2031 Class A Common Stock 339,733 $7 D
Stock Options (Right to Buy) (1) 08/24/2031 Class A Common Stock 1,420 $7 I By: Spouse(4)
Stock Options (Right to Buy) (3) 08/24/2031 Class A Common Stock 2,840 $7 I By: Spouse(4)
Explanation of Responses:
1. Currently exercisable.
2. Includes 113,244 stock options which vest on September 2, 2023, and 226,489 stock options which vest on September 2, 2024.
3. Includes 1,420 stock options which vest on September 1, 2023, and 1,420 stock options which vest on September 1, 2024.
4. Securities held by the Reporting Person's spouse. Reporting Person expressly disclaims any beneficial ownership of spouse's shares.
Remarks:
See Exhibit 24 - Power of Attorney
/s/ Apoorv Dwivedi as Attorney-in-Fact 11/08/2022
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.