Israel
|
Not Applicable
|
(State or other jurisdiction of
incorporation or organization) |
(I.R.S. Employer
Identification No.) |
Ronen Kantor, Esq.
Doron Tikotzky Kantor
Gutman & Amit Gross
B.S.R. 4 Tower, 33 Floor
7 Metsada Street,
Bnei Brak 5126112 Israel
Tel: +972 3 613 3371
|
Gary Emmanuel, Esq.
Mark Selinger, Esq.
Eyal Peled, Esq.
McDermott Will & Emery LLP
One Vanderbilt Avenue New York, NY 10017
(212) 547 5400
|
Large accelerated filer
|
☐
|
|
Accelerated filer
|
☐
|
Non-accelerated filer
|
☒
|
|
Smaller reporting company
|
☐
|
|
|
|
Emerging growth company
|
☒
|
• |
a monetary liability incurred by or imposed on him or her in favor of another person pursuant to a judgment, including a settlement or arbitrator’s award approved by a court. However, if an undertaking to indemnify an office holder with
respect to such liability is provided in advance, then such an undertaking must be limited to certain events which, in the opinion of the board of directors, can be foreseen based on the company’s activities when the undertaking to indemnify
is given, and to an amount or according to criteria determined by the board of directors as reasonable under the circumstances, and such undertaking shall detail the foreseen events and amount or criteria;
|
• |
reasonable litigation expenses, including reasonable attorneys’ fees, incurred by the office holder as (1) a result of an investigation or proceeding instituted against him or her by an authority authorized to conduct such investigation or
proceeding, provided that (i) no indictment was filed against such office holder as a result of such investigation or proceeding; and (ii) no financial liability was imposed upon him or her as a substitute for the criminal proceeding as a
result of such investigation or proceeding or, if such financial liability was imposed, it was imposed with respect to an offense that does not require proof of criminal intent or (2) in connection with a monetary sanction;
|
• |
a monetary liability imposed on him or her in favor of an injured party at an Administrative Procedure (as defined below) pursuant to Section 52(54)(a)(1)(a) of the Securities Law;
|
• |
expenses incurred by an office holder in connection with an Administrative Procedure under the Securities Law, including reasonable litigation expenses and reasonable attorneys’ fees; and
|
• |
reasonable litigation expenses, including attorneys’ fees, incurred by the office holder or imposed by a court in proceedings instituted against him or her by the company, on its behalf, or by a third-party, or in connection with criminal
proceedings in which the office holder was acquitted or as a result of a conviction for an offense that does not require proof of criminal intent.
|
• |
a breach of the duty of care to the company or to a third-party, to the extent such a breach arises out of the negligent conduct of the office holder;
|
• |
a monetary liability imposed on the office holder in favor of a third-party;
|
• |
a monetary liability imposed on the office holder in favor of an injured party at an Administrative Procedure pursuant to Section 52(54)(a)(1)(a) of the Securities Law; and
|
• |
expenses incurred by an office holder in connection with an Administrative Procedure, including reasonable litigation expenses and reasonable attorneys’ fees.
|
• |
a breach of the duty of loyalty, except for indemnification and insurance for a breach of the duty of loyalty to the company to the extent that the office holder acted in good faith and had a reasonable basis to believe that the act would
not prejudice the company;
|
• |
a breach of the duty of care committed intentionally or recklessly, excluding a breach arising out of the negligent conduct of the office
holder;
|
• |
an act or omission committed with intent to derive unlawful personal benefit; or
|
• |
a fine or forfeit levied against the office holder.
|
|
PAINREFORM LTD.
|
|
|
|
|
|
|
By:
|
/s/ Ilan Hadar
|
|
|
|
Name:
|
Ilan Hadar
|
|
|
Title:
|
Chief Executive Officer
|
|
Signatures
|
|
Title
|
|
Date
|
|
|
|
|
|
/s/ Ilan Hadar
|
|
Chief Executive Officer
|
|
June 29, 2022
|
Ilan Hadar
|
|
(Principal Executive, Financial and Accounting Officer)
|
|
|
|
|
|
|
|
/s/ Ehud Geller
|
|
Chairman of the Board and Director
|
|
June 29, 2022
|
Ehud Geller
|
|
|
|
|
|
|
|
|
|
/s/ Prof. Eli Hazum
|
|
Chief Technology Officer and Director
|
|
June 29, 2022
|
Prof. Eli Hazum
|
|
|
|
|
|
|
|
|
|
/s/ Efi Cohen-Arazi
|
|
Director
|
|
June 29, 2022
|
Efi Cohen-Arazi
|
|
|
|
|
/s/ Dr. Ellen S. Baron
|
|
Director
|
|
June 29, 2022
|
Dr. Ellen S. Baron
|
|
|
|
|
|
|
|
|
|
/s/ Augustine Lawlor
|
|
Director
|
|
June 29, 2022
|
Augustine Lawlor
|
|
|
|
|
Puglisi & Associates
|
|
||
|
|
|
|
By:
|
/s/ Donald J. Puglisi
|
|
|
|
Name:
|
Donald J. Puglisi
|
|
|
Title:
|
Managing Director
|
|
Exhibit
Number |
|
Description of Exhibit
|
*
|
Filed herewith.
|
Painreform Ltd.
|
65 Yigal Alon St.
|
Tel Aviv, 67443164
|
Israel
|
mail@dtkgg.com
www.dtkgg.com
|
Haifa & Northern: 7 Palyam Blvd.
Haifa,
(Phoenix House) 7th Floor, 3309510
Tel. +972-4-8147500 | Fax 972-4-8555976
Banking & Collection, 6th Floor
Tel. 972-4-8353700 | Fax 972-4-8702477
Romania: 7 Franklin, 1st District, Bucharest
Cyprus: 9 Zenonos Kitieos St., 2406 Engomi, Nicosia
|
Central: B.S.R. Tower 4, 33th Floor,
7 metsada St. Bnei Brak, 5126112
Tel. 972-3-6109100 | Fax +972-3-6127449
Tel. 972-3-6133371 | Fax +972-3-6133372
Tel. 972-3-7940700 | Fax +972-3-7467470
Tel. 972-3-6114455 | Fax +972-3-6131170
SRF New York: 1185 Avenue of the Americas,37th Floor | New York, NY 10036
|
Tel-Aviv, Israel
|
/s/ Kesselman & Kesselman
|
June 29, 2022
|
Certified Public Accountants (Isr.)
|
|
A member of PricewaterhouseCoopers International Limited
|
|
|
|
Kesselman & Kesselman, 146 Derech Menachem Begin St. Tel-Aviv 6492103, Israel,
|
|
P.O Box 7187 Tel-Aviv 6107120, Telephone: +972 -3- 7954555, Fax:+972 -3- 7954556, www.pwc.com/il
|
|
|
Kesselman & Kesselman is a member firm of PricewaterhouseCoopers International Limited, each member firm of which is a
separate legal entity
|
Security
Type |
|
Security
Class Title |
|
Fee
Calculation Rule |
|
Amount
Registered(1) |
|
|
Proposed
Maximum Offering
Price Per Share |
|
|
Maximum
Aggregate Offering Price
|
|
|
Fee Rate
|
|
|
Amount of
Registration Fee |
|
|||||
Equity
|
|
Ordinary shares, par value NIS 0.03 per share, reserved for issuance pursuant to options outstanding the 2019 PainReform Option
Plan
|
|
457(c); 457(h)
|
|
|
1,000,000(1)
|
|
$
|
1.02(2)
|
|
$
|
1,020,000
|
|
|
$
|
0.0000927
|
|
|
$
|
94.56
|
|
||
Total Offering Amount
|
|
|
|
|
|
|
|
|
|
|
|
$
|
1,020,000
|
|
|
|
|
|
|
$
|
94.56
|
|
||
Total Fees Previously Paid
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
—
|
|
||
Total Fee Offsets
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
—
|
|
||
Net Fee Due
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
94.56
|
|
|
(1)
|
Pursuant to Rule 416(a) under the Securities Act of 1933, as amended, this registration statement shall also cover any additional ordinary shares that become issuable under the 2019
PainReform Option Plan by reason of any stock dividend, stock split, recapitalization or other similar transaction.
|
|
(2)
|
The proposed maximum offering price per share is calculated in accordance with Rules 457(c) and 457(h) under the Securities
Act, solely for purposes of calculating the registration fee on the basis of $1.02 per share, the average of the high and low price of the Registrant’s ordinary shares as reported on the Nasdaq Capital Market on June 28, 2022.
|
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