Exhibit
4.3


 


Microbot
Medical Inc.


2020
Omnibus Performance Award Plan


 


NQO
AWARD AGREEMENT


 


Microbot
Medical Inc. (the “Corporation”), pursuant to the terms of the Microbot Medical Inc. 2020 Omnibus Performance
Award Plan (the “Plan”) and the Non-Qualified Stock Option Award attached to this NQO Award Agreement, hereby
grants to the individual named below the option to purchase the number of shares of the Corporation’s Common Stock, also
as is set forth below. The terms of this NQO Award Agreement are subject to all of the provisions of the Plan and the attached
Non-Qualified Stock Option Award, with such provisions being incorporated herein by reference.


 


	1.	Date
    of Grant:		 
	 	 	 	 
	2.	Name
    of Participant:		 
	 	 	 	 
	3.	Number
    of Shares:		 Shares
    of Common Stock
	 	 	 	 
	4.	Exercise
    Price:		 per
    Share of Common Stock.
	 	 	 	 
	5.	Vesting
    of Options: [ADD APPENDIX CONTAINING PERFORMANCE VESTING PROVISIONS IF DESIRED]


 


	Vesting
    Date	 	No.
    of Shares Vested
	 	 	 
	 	 	 
	 	 	 
	 	 	 


 


	6.	Expiration
    Date:		 


 


The
Participant acknowledges receipt of, and understands and agrees to be bound by all of the terms of, this NQO Award Agreement,
the attached Non-Qualified Stock Option Award and the Plan, and that the terms thereof supersede any and all other written or
oral agreements between the Participant and the Corporation regarding the subject matter contained herein. 


 


	Microbot
    Medical Inc.	 	 	[NAME
    OF PARTICIPANT]:
	 	 	 
	By:		 	 	                  
	Title:		 	Date:	 
	Date:
	 	 	 	 


 




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NON-QUALIFIED
STOCK OPTION AWARD


 


THIS
AGREEMENT made as of the grant date set forth in Section 1 of the NQO Award Agreement to which this Agreement is attached
(the “Date of Grant”) between Microbot Medical Inc. a Delaware corporation (hereinafter referred to as the
“Corporation”), and the individual identified in Section 2 of the NQO Award Agreement to which this Agreement
is attached (hereinafter referred to as the “Participant”).


 


W
I T N E S S E T H:


 


WHEREAS,
the Corporation desires, in connection with the employment of the Participant and in accordance with the Microbot Medical Inc.
2020 Omnibus Performance Award Plan (the “Plan”), to provide the Participant with an opportunity to acquire
Common Stock of the Corporation on favorable terms and thereby increase his proprietary interest in the continued progress and
success of the business of the Corporation;


 


NOW,
THEREFORE, in consideration of the premises, the mutual covenants herein set forth and other good and valuable consideration,
the Corporation and the Participant hereby agree as follows:


 


1.
Confirmation of Grant of Option. Pursuant to a determination by the Committee, the Corporation, subject to the terms of
the Plan, the NQO Award Agreement and this Agreement, hereby grants to the Participant as a matter of separate inducement and
agreement, and in addition to and not in lieu of salary or other compensation for services, the right to purchase (hereinafter
referred to as the “Option”) an aggregate number of shares of Common Stock as is set forth in Section 3 of
the NQO Award Agreement to which this Agreement is attached, subject to adjustment as provided in the Plan (such shares, as adjusted,
hereinafter being referred to as the “Shares”). The Option is not intended to qualify as an incentive
stock option under Section 422 of the Internal Revenue Code of 1986, as amended (the “Code”).


 


2.
Exercise Price. The purchase price of shares of Common Stock covered by the Option will be the per share amount set forth
in Section 4 of the NQO Award Agreement to which this Agreement is attached, at all times being not less than 100% of the Fair
Market Value of one share of Common Stock on the Date of Grant, subject to adjustment as provided in the Plan.


 


3.
Exercise of Option. The Option shall be exercisable on the terms and conditions hereinafter set forth:


 


(a)
The Option shall become exercisable cumulatively as to the number of Shares originally subject thereto (after giving effect to
any adjustment pursuant to the Plan), and on the dates, as set forth in Section 5 of the NQO Award Agreement to which this Agreement
is attached. [INCLUDE REFERENCE TO PERFORMANCE VESTING IF APPROPRIATE]


 




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(b)
The Option may be exercised pursuant to the provisions of this Section 3, by notice and payment to the Corporation as provided
in Sections 8 and 9 hereof.


 


4.
Term of Option. The term of the Option shall be the period of time beginning on the Date of Grant as is set forth in Section
1 of the NQO Award Agreement to which this Agreement is attached and shall expire on the date set forth in Section 6 of the NQO
Award Agreement to which this Agreement is attached, subject to earlier termination or cancellation as provided in this Agreement.



 


5.
Non-transferability of Option. The Option shall not be assigned, transferred or otherwise disposed of, or pledged or hypothecated
in any way, and shall not be subject to execution, attachment or other process, except as may be provided in the Plan. Any assignment,
transfer, pledge, hypothecation or other disposition of the Option attempted contrary to the provisions of the Plan, or any levy
of execution, attachment or other process attempted upon the Option, will be null and void and without effect. Any attempt to
make any such assignment, transfer, pledge, hypothecation or other disposition of the Option will cause the Option to terminate
immediately upon the happening of any such event; provided, however, that any such termination of the Option under the foregoing
provisions of this Section 5 will not prejudice any rights or remedies which the Corporation or any Affiliate may have under this
Agreement or otherwise.


 


6.
Exercise Upon Termination of Service. (a) If the Participant at any time incurs a Termination of Service (i) by reason
of his discharge for Cause or (ii) due to his voluntary Termination of Service [without the written consent of the Committee][in
the absence of Good Reason], the Option shall, at the time of such Termination of Service, terminate and the Participant shall
forfeit all rights hereunder. If, however, the Participant [for any other reason] (other than Disability or death) incurs
a Termination of Service [on or after the first date upon which he would have been entitled to exercise the Option under the
provisions of Section 3 hereof] , the Option may be exercised by the Participant [with respect to all or any part of the
shares of Common Stock as to which the Participant had not exercised the Option at the time of his Termination of Service (regardless
of whether the Option was fully exercisable at such time)] [(to the same extent the Participant would have been entitled under
Section 3 hereof to exercise the Option immediately prior to his Termination of Service)], at any time within [________days/months]
after such Termination of Service, at the end of which period the Option, to the extent not then exercised, shall terminate
and the Participant shall forfeit all rights hereunder, even if the Participant subsequently returns to the Service of the Corporation
or any Affiliate. In no event, however, may the Option be exercised after the expiration of the term provided in Section 4 hereof.



 


(b)
The Option shall not be affected by any change of duties or position of the Participant so long as he continues to be in full-time
Service of the Corporation or of any Affiliate thereof. If the Participant is granted a temporary leave of absence of 90 days
or less, such leave of absence shall be deemed a continuation of his Service by the Corporation or of any Affiliate thereof for
the purposes of this Agreement, but only if and so long as the corporation consents thereto.


 




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7.
Exercise Upon Death or Disability. (a) If the Participant dies while he is in the Service of the Corporation or by any
Affiliate, [and on or after the first date upon which he would have been entitled to exercise the Option under the provisions
of Section 3 hereof], the Option may be exercised by the estate of the Participant (or by the person or persons who acquire
the right to exercise the Option by written designation of the Participant) [with respect to all or any part of the shares
of Common Stock as to which the deceased Participant had not exercised the Option at the time of his death (regardless of whether
the Option was fully exercisable at such time)] [(to the same extent the Participant would have been entitled under Section 3
hereof to exercise the Option immediately prior to his death)], at any time within [________ days/months/years] after
the death of the Participant, at the end of which period the Option, to the extent not then exercised, shall terminate and the
estate or other beneficiaries shall forfeit all rights hereunder. In no event, however, may the Option be exercised after the
expiration of the term provided in Section 4 hereof.


 


(b)
In the event that the Participant incurs a Termination of Service by reason of the Disability of the Participant [and on or
after the first date upon which he would have been entitled to exercise the Option under the provisions of Section 3 hereof],
the Option may be exercised by the Participant [with respect to all or any part of the shares of Common Stock as to which he
had not exercised the Option at the time of his Disability (regardless of whether the Option was fully exercisable at such time)]
[(to the same extent the Participant would have been entitled under Section 3 hereof to exercise the Option immediately prior
to his employment termination due to Disability)] within the period ending [________ days/months/years] after the date
of such Termination of Service, at the end of which period the Option, to the extent not then exercised, shall terminate and the
Participant shall forfeit all rights hereunder even if the Participant subsequently returns to the Service of the Corporation
or any Affiliate. In no event, however, may the Option be exercised after the expiration of the term provided in Section 4 hereof.


 


8.
Method of Exercise of Option. (a) Subject to the terms and conditions of this Agreement, the Option shall be exercisable
by notice in the manner set forth in Exhibit “A” hereto (the “Notice”) and provision for
payment to the Corporation in accordance with the procedure prescribed herein. Each such Notice shall:


 


(i)
state the election to exercise the Option and the number of Shares with respect to which it is being exercised;


 


(ii)
be signed by the Participant or the person or persons entitled to exercise the Option and, if the Option is being exercised by
any person or persons other than the Participant, be accompanied by proof, satisfactory to counsel to the Corporation, of the
right of such other person or persons to exercise the Option; 


 


(iii)
include payment of the full purchase price for the shares of Common Stock to be purchased pursuant to such exercise of the Option;
and


 


(iv)
be received by the Corporation on or before the date of the expiration of this Option. In the event the date of expiration of
this Option falls on a day which is not a regular business day at the Corporation’s executive office in [CITY/STATE]
then such written Notice must be received at such office on or before the last regular business day prior to such date of expiration.


 




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(b)
Payment of the purchase price of any shares of Common Stock, in respect of which the Option shall be exercised, shall be made
by the Participant or such person or persons at the place specified by the Corporation on the date the Notice is received by the
Corporation (i) by delivering to the Corporation a certified or bank cashier’s check payable to the order of the Corporation,
[(ii) by delivering to the Corporation properly endorsed certificates of shares of Common Stock (or certificates accompanied
by an appropriate stock power) with signature guaranties by a bank or trust company], [(iii) by having withheld from the total
number of shares of Common Stock to be acquired upon the exercise of this Option a specified number of such shares of Common Stock]
or [(iv) by any combination of the foregoing]. [For purposes of the immediately preceding sentence, an exercise effected by the
tender of Common Stock (or deemed to be effected by the tender of Common Stock) may only be consummated with Common Stock held
by the Participant for a period of six (6) months or acquired by the Participant other than under the Plan (or a similar plan
maintained by the Corporation).]


 


(c)
The Option shall be deemed to have been exercised with respect to any particular shares of Common Stock if, and only if, the preceding
provisions of this Section 8 and the provisions of Section 9 hereof shall have been complied with, in which event the Option shall
be deemed to have been exercised on the date the Notice was received by the Corporation. Anything in this Agreement to the contrary
notwithstanding, any Notice given pursuant to the provisions of this Section 8 shall be void and of no effect if all of the preceding
provisions of this Section 8 and the provisions of Section 9 shall not have been complied with.


 


(d)
The certificate or certificates for shares of Common Stock as to which the Option shall be exercised will be registered in the
name of the Participant (or in the name of the Participant’s estate or other beneficiary if the Option is exercised after
the Participant’s death), or if the Option is exercised by the Participant and if the Participant so requests in the notice
exercising the Option, will be registered in the name of the Participant and another person jointly, with right of survivorship
and will be delivered as soon as practical after the date the Notice is received by the Corporation (accompanied by full payment
of the exercise price), but only upon compliance with all of the provisions of this Agreement.


 


(e)
If the Participant fails to accept delivery of and pay for all or any part of the number of Shares specified in such Notice, his
right to exercise the Option with respect to such undelivered Shares may be terminated in the sole discretion of the Committee.
The Option may be exercised only with respect to full Shares.


 


(f)
The Corporation shall not be required to issue or deliver any certificate or certificates for shares of its Common Stock purchased
upon the exercise of any part of the Option prior to the payment to the Corporation, upon its demand, of any amount requested
by the Corporation for the purpose of satisfying its minimum statutory liability, if any, to withhold federal, state or local
income or earnings tax or any other applicable tax or assessment (plus interest or penalties thereon, if any, caused by a delay
in making such payment) incurred by reason of the exercise of this Option or the transfer of shares thereupon. Such payment shall
be made by the Participant in cash or, with the written consent of the Corporation, by tendering to the Corporation shares of
Common Stock equal in value to the amount of the required withholding. In the alternative, the Corporation may, at its option,
satisfy such withholding requirements by withholding from the shares of Common Stock to be delivered to the Participant pursuant
to an exercise of the Option a number of shares of Common Stock equal in value to the amount of the required withholding.


 




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9.
Approval of Counsel. The exercise of the Option and the issuance and delivery of shares of Common Stock pursuant thereto
shall be subject to approval by the Corporation’s counsel of all legal matters in connection therewith, including, but not
limited to, compliance with the requirements of the Securities Act of 1933, as amended, and the Securities Exchange Act of 1934,
as amended, and the rules and regulations thereunder, and the requirements of any stock exchange or automated trading medium upon
which the Common Stock may then be listed or traded.


 


10.
Reservation of Shares. The Corporation shall at all times during the term of the Option reserve and keep available such
number of shares of Common Stock as will be sufficient to satisfy the requirements of this Agreement.


 


11.
Limitation of Action. The Participant and the Corporation each acknowledges that every right of action accruing to him
or it, as the case may be, and arising out of or in connection with this Agreement against the Corporation or an Affiliate, on
the one hand, or against the Participant, on the other hand, shall, irrespective of the place where an action may be brought,
cease and be barred by the expiration of three years from the date of the act or omission in respect of which such right of action
arises.


 


12.
Benefits of Agreement. This Agreement shall inure to the benefit of the Corporation, the Participant and their respective
heirs, executors, administrators, personal representatives, successors and permitted assignees.


 


13.
Severability. In the event that any one or more provisions of this Agreement shall be deemed to be illegal or unenforceable,
such illegality or unenforceability shall not affect the validity and enforceability of the remaining legal and enforceable provisions
hereof, which shall be construed as if such illegal or unenforceable provision or provisions had not been inserted.


 


14.
Service. Nothing contained in this Agreement shall be construed as (a) a contract of employment between the Participant
and the Corporation or any Affiliate, (b) a right of the Participant to be continued in the Service of the Corporation or of any
Affiliate, or (c) a limitation of the right of the Corporation or of any Affiliate to discharge the Participant at any time, with
or without cause (subject to any applicable employment agreement).


 


15.
Definitions. Unless otherwise defined herein, all capitalized terms used in this Agreement shall have the same definitions as
set forth in the Plan.


 




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16.
Incorporation of Terms of Plan. This Agreement shall be interpreted under, and subject to, all of the terms and provisions
of the Plan, which are incorporated herein by reference. In the event of any inconsistencies between the provisions of this Agreement
and the provisions of the Plan, the provisions of the Plan shall control.


 


17.
No Strict Construction. The language used in this Agreement shall be deemed to be the language chosen by the parties hereto
to express their mutual intent, and no rule of strict construction shall apply against any party.


 


18.
Injunctive Relief. The restrictions set forth in this Agreement are necessary for the protection of the business and goodwill
of the Corporation and are considered by the Participant to be reasonable for such purpose. The Participant agrees that any breach
by the Participant of any term set forth under this Agreement is likely to cause the Corporation substantial and irrevocable damage
and, therefore, any such breach shall entitle the Corporation, in addition to any other legal remedies available to it, to apply
to any court of competent jurisdiction to enjoin such breach, threatened breach, alleged breach or alleged threatened breach.
The Parties hereto understand and intend that each restriction set forth herein shall be construed as separable and divisible
from every other restriction, and that the unenforceability, in whole or in part, of any other restriction, will not affect the
enforceability of the remaining restrictions and that one or more or all of such restrictions may be enforced in whole or in part
as the circumstances warrant. The Participant hereby acknowledges that he is fully cognizant of the restrictions imposed upon
him pursuant to the terms of this Agreement.


 


BY
WAY OF THEIR EXECUTION OF THE NQO AWARD AGREEMENT TO WHICH THIS AGREEMENT IS ATTACHED, the Corporation and the Participant
(and each and every one of their heirs, successors and assigns) agree to be bound by each and every one of the terms set forth
in this Agreement.


 




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EXHIBIT
A


 


NON-QUALIFIED
OPTION EXERCISE FORM


 


	 	[DATE]


 


Microbot
Medical Inc.


[Address]


[City,
State and Zip Code]


Attention:
[OFFICER]


 


Dear
Sirs:


 


Pursuant
to the provisions of the Non-Qualified Stock Option Award and related NQO Award Agreement dated [        ]
(collectively, the “Agreement”), whereby you have granted to me a Non-Qualified Stock Option (the “Option”)
to purchase up to [ ] shares of the Common Stock of Microbot Medical Inc. (the “Corporation”) subject to the terms
of the Agreement, I hereby notify you that I elect to exercise my option to purchase [        ]
of the shares of Common Stock covered by such Option at the [$___] per share price specified therein. In full payment of the price
for the shares being purchased hereby, I am delivering to you herewith (i) certified or bank cashier’s check payable to
the order of the Corporation in the amount of $____________, or (ii) a certificate or certificates for [       ]
shares of Common Stock of the Corporation, and which have a fair market value as of the date hereof of $___________, [and a certified
or bank cashier’s check, payable to the order of the Corporation, in the amount of $________________]. Any such stock certificate
or certificates are endorsed, or accompanied by an appropriate stock power, to the order of the Corporation, with my signature
guaranteed by a bank or trust company or by a member firm of the New York Stock Exchange. [I hereby acknowledge that I am purchasing
these shares for investment purposes only and not for resale in violation of any federal or state securities laws.]


 


	 	Very
    truly yours,
	 	 
	 	
	 	[Address]
	 	(For
        notices, reports, dividend checks and 

        other
        communications to stockholders.)



 




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