CUSIP
No.
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13G
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Page 2 of 5 Pages
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1.
NAMES OF REPORTING PERSON
S.S.
OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Leon
Lewkowicz
2.
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP:
(a)
☐
(b)
☐
3.
SEC USE ONLY
4.
CITIZENSHIP OR PLACE OF ORGANIZATION
Israel
5.
SOLE VOTING POWER, NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON – 2,318,552*
6.
SHARED VOTING POWER - None
7. SOLE DISPOSITIVE POWER – 2,318,552*
8.
SHARED DISPOSITIVE POWER – None
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
- 2,318,552*
10.
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN
SHARES
☐
11.
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.0%
**
12.
TYPE OF REPORTING PERSON
IN
* This Amendment No. 4 to Schedule 13G is
being filed to reflect a sale of shares of common stock owned by the Reporting Person from June 22, 2017 to June 23, 2017.
** Based on an outstanding number of approximately
27,951,333 shares of common stock as reported by the Company on Form 10-Q as of March 31, 2017 and the 1,525,000 shares issued
by the Company as reported on Form 8-K filed on June 14, 2017 and 3,750,000 shares issued by the Company as reported by the Form
424b filed on June 6, 2017.
CUSIP
No.
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|
13G
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Page 3 of 5 Pages
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ITEM
1 (a) NAME OF ISSUER: Microbot Medical, Inc.
ITEM
1 (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
25
Recreation Park Drive, Unit 108, Hingham, Massachusetts 02043
ITEM
2 (a) NAME OF PERSON FILING: Leon Lewkowicz
ITEM
2 (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE:
Gordon
Street 10/7, 63458 Tel-Aviv, Israel
ITEM
2 (c) CITIZENSHIP: Israel
ITEM
2 (d) TITLE OF CLASS OF SECURITIES: Common Stock
ITEM
2 (e) CUSIP NUMBER:
ITEM
3 IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B) OR 13D-2(B): Not applicable
ITEM
4 OWNERSHIP
(a) AMOUNT BENEFICIALLY OWNED: 2,318,552*
(b)
PERCENT OF CLASS: 7.0% **
(c)
NUMBER OF SHARES AS TO WHICH SUCH PERSON HAS:
(i)
SOLE POWER TO VOTE OR DIRECT THE VOTE
2,318,552*
(ii)
SHARED POWER TO VOTE OR DIRECT THE VOTE
0
Shares
(iii)
SOLE POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF
2,318,552*
(iv)
SHARED POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF
0
Shares
CUSIP
No.
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13G
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Page 4 of 5 Pages
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ITEM
5 OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS
Not
applicable
ITEM
6 OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON
Not
applicable
ITEM 7
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IDENTIFICATION AND
CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY
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Not
applicable
ITEM
8 IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF A GROUP
Not
applicable
ITEM
9 NOTICE OF DISSOLUTION OF GROUP
Not
applicable
CUSIP
No.
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13G
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Page 5 of 5 Pages
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SIGNATURE
After
reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true,
complete and correct.
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June
26, 2017
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(Date)
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/s/
Leon Lewkowicz
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(Signature)
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Leon
Lewkowicz
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(Name/Title)
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