Initial Statement of Beneficial Ownership (3)
26 March 2021 - 9:48AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Darvish Nissim |
2. Date of Event Requiring Statement (MM/DD/YYYY)
3/16/2021
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3. Issuer Name and Ticker or Trading Symbol
Chemomab Therapeutics Ltd. [CMMB]
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(Last)
(First)
(Middle)
C/O CHEMOMAB THERAPEUTICS LTD.,, KIRYAT ATIDIM, BUILDING 7 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Street)
TEL AVIV, L3 6158002
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Option to purchase American Depositary Shares | (1) | 10/27/2026 | American Depositary Shares (2) | 10123 | $0.80 | D | |
| Explanation of Responses: |
| (1) | The options reported in this row have all vested and are exercisable as of the date hereof, subject to the Reporting Person's continued service. |
| (2) | Each American Depositary Share (ADS) represents twenty (20) ordinary shares, no par value, of the Issuer. |
Remarks:
Exhibit 24.1: Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Darvish Nissim
C/O CHEMOMAB THERAPEUTICS LTD.,
KIRYAT ATIDIM, BUILDING 7
TEL AVIV, L3 6158002 | X |
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Signatures
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| /s/ Matthew Rudolph, Esq., Attorney-in-Fact for Nissim Darvish | | 3/25/2021 |
| **Signature of Reporting Person | Date |
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