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*
Mor George Adi

(Last) (First) (Middle)
15 KAFRISIN ST.

(Street)
TEL AVIV L3 6901658

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/16/2021
3. Issuer Name and Ticker or Trading Symbol
Chemomab Therapeutics Ltd. [ CMMB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Executive Officer
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)
American Depositary Shares(1) 649,550 D
American Depositary Shares(1) 514,495 I By Kobi George, the Reporting Person's spouse
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
Option to purchase American Depositary Shares (2) 03/15/2028 American Depositary Shares(1) 131,698 1.49 D
Option to purchase American Depositary Shares (3) 10/27/2026 American Depositary Shares(1) 33,725 0.8 I By Kobi George, the Reporting Person's spouse
Explanation of Responses:
1. Each American Depositary Share (ADS) represents twenty (20) ordinary shares, no par value, of the Issuer.
2. 98,770 of these options have vested and are exercisable as of the date hereof. An additional 32,928 options will become exercisable in four equal installments, at each three month anniversary of the grant date, commencing on June 15, 2021, subject to the Reporting Person's continued service.
3. These options have vested and are exercisable as of the date hereof, subject to the Reporting Person's continued service.
Remarks:
Exhibit 24.1: Power of Attorney
/s/ Matthew Rudolph, Esq., Attorney-in-Fact for Adi Mor George 03/25/2021
** 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.