SEC Form 4

FORM 4		UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940	OMB APPROVAL OMB Number: 3235-0287 Estimated average burden hours per response: 0.5
X	Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person* ALPHA CAPITAL ANSTALT (Last) (First) (Middle) LETTSTRASSE 32, 9490 VADUZ (Street) LICHTENSTEIN N2 (City) (State) (Zip)	2. Issuer Name and Ticker or Trading Symbol Microbot Medical Inc. [ MBOT ]	5. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 10% Owner Officer (give title below) Other (specify below)
	3. Date of Earliest Transaction (Month/Day/Year) 11/28/2016
	4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
			Code	V	Amount	(A) or (D)	Price
Common Stock	11/28/2016	(1)	J		9,753,549(1)(2)(3)	A	$0.00(1)	9,753,549(1)(2)(3)	D
Common Stock	11/28/2016	(1)	J		7,977,092(1)(2)(3)	D	$0.00(1)	1,776,457(1)(2)(3)	D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Convertible Debenture	$0.64	11/28/2016	(2)	J		1,776,457(2)(3)		(2)	(2)	Common Stock	(2)(3)	(2)	1,776,457(2)(3)	D

Explanation of Responses:

1. Pursuant to a merger agreement effective as of November 28, 2016 reported in a Form 8-K filed by the Issuer on November 29, 2016, Alpha Capital Anstalt ("Alpha") was issued 9,753,549 shares of common stock, which immediately following the merger were surrendered by Alpha to the Issuer pursuant to the terms of a Right to Shares Agreement. The Right to Shares Agreement contains a 4.99% "blocker" provision designed to prevent Alpha from being a beneficial owner of more than 4.99% of the Issuer's Common Stock. Therefore, Alpha is no longer an affiliate of the Issuer.

2. In connection with the merger on November 28, 2016, Alpha exchanged a non-convertible note for a convertible debenture containing a 4.99% "blocker" provision.

3. The number of shares owned by Alpha does not include any shares issued to Lane Ventures, Inc., a consultant of the Issuer. Alpha disclaims beneficial ownership of any of the shares issued to Lane Ventures, Inc.

	/s/ Konrad Ackermann Director of Alpha Capital Anstalt	11/30/2016
	** Signature of Reporting Person	Date
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