Document:

MICROBOT
MEDICAL INC.

2017
EQUITY INCENTIVE PLAN

 

STOCK
OPTION AGREEMENT

 

STOCK
OPTION AGREEMENT, dated as of [_____] [__], 2017, between Microbot Medical Inc., a Delaware corporation (the “Company”),
and [_____] (the “Grantee”).

 

W
I T N E S S E T H:

 

WHEREAS,
as of September 12, 2017, the Company adopted the 2017 Equity Incentive Plan (the “Plan”), which Plan authorizes,
among other things, the grant of options to purchase shares of common stock, $0.01 par value (“Common Stock”), of
the Company to directors, officers and employees of the Company and to other individuals; and

 

WHEREAS,
the Company’s Board of Directors or Compensation Committee of the Board of Directors, as administrator of the Plan, has
determined that it would be in the best interests of the Company to grant the option documented herein.

 

NOW,
THEREFORE, the parties hereto hereby agree as follows:

 

1.
Definitions. Capitalized terms not defined in this Agreement shall have the meaning ascribed to such terms in the Plan.

 

2.
Grant of Option. Subject to the terms and conditions of the Plan and as set forth herein, the Company hereby grants to
the Grantee, as of date hereof, an option (the “Option”) to purchase from the Company all or any part of an aggregate
number of [__] shares of Common Stock (the “Optioned Shares”).

 

3.
Vesting. Subject to such further limitations as are provided in the Plan and as set forth herein, the Option shall become
exercisable at a per share price of $[___] (“Exercise Price”), the Grantee having the right hereunder to purchase
from the Company the indicated number of Optioned Shares upon exercise of the Option, on and after such dates, in cumulative fashion:

 

	Exercise

        Date
	 	Non−Qualified

        Stock
        Options
	 	Incentive
                                         

                                         Stock 

                                         Options
	 	102
                                         Capital Gains Track Option Award (with Trustee) (Israel)
	 	102
                                         Ordinary Income Track Option Award (with Trustee) (Israel)
	 	102
                                         Non-

                                         Trustee 

                                         Option

                                         Award

                                         (Israel)
	 	3(9)
                                         Option Award

                                         (Israel)

	 	 	 	 	 	 	 	 	 	 	 	 	 
	[__]	 	[__]	 	[__]	 	[__]	 	[__]	 	[__]	 	[__]

 

Only
those Optioned Shares indicated above as “Incentive Stock Options” are intended by the parties hereto to be, and be
treated as, “incentive stock options” (as such term is defined under Section 422 of the Code). The Option may not
be exercised with respect to less than 100 Optioned Shares (or the Optioned Shares then subject to purchase under the Option,
if less than 100 shares) or for any fractional shares.

 

    	 

    	 

    

 

4.
Termination of Option. The Option, to the extent not previously exercised and subject to Section 7(g) of the Plan, shall
terminate and become null and void on [_____][__], 20[__].

 

5.
Exercisability. (a) Upon a termination of the Grantee’s employment, the Option shall be exercisable only to the extent
that the Option is vested and is in effect on the date of such termination of the Grantee’s employment.

 

(b)
To the extent exercisable, the Option may be exercised by a legal representative on behalf of the Grantee in the event of such
permanent disability, or, in the case of the death of the Grantee, by the estate of the Grantee or by any person or persons who
acquired the right to exercise the Option by bequest or inheritance or by reason of the death of the Grantee.

 

6.
Manner of Exercise. (a) Subject to Section 7(h) of the Plan, the Option may be exercised in full at one time or in part
from time to time for the number of Optioned Shares then exercisable by giving written notice, signed by the person exercising
the Option, to the Company, stating the number of Optioned Shares with respect to which the Option is being exercised and the
date of exercise thereof, which date shall be at least five days after the giving of such notice.

 

(b)
The Company shall be under no obligation to issue any Optioned Shares unless the person exercising the Option, in whole or in
part, shall give a written representation and undertaking to the Company which is satisfactory in form and substance to counsel
for the Company and upon which, in the opinion of such counsel, the Company may reasonably rely, that he or she is acquiring such
Optioned Shares for his or her own account as an investment and not with a view to, or for sale in connection with, the distribution
of any such Optioned Shares, and that he or she will make no transfer of the same except in compliance with any rules and regulations
in force at the time of such transfer under the Securities Act of 1933, or any other applicable law.

 

(c)
Upon exercise of the Option in the manner prescribed by this Section 6 and otherwise pursuant to the Plan, delivery of a certificate
for the Optioned Shares then being purchased shall be made at the principal office of the Company to the person exercising the
Option within a reasonable time after the date of exercise specified in the notice of exercise.

 

7.
Non−Transferability of Option. The Option shall not be assignable or transferable by the Grantee other than by will
or the laws of descent and distribution, and shall be exercisable during the lifetime of the Grantee only by the Grantee. The
Option shall terminate and become null and void immediately upon the bankruptcy of the Grantee, or upon any attempted assignment
or transfer except as herein provided, including without limitation, any purported assignment, whether voluntary or by operation
of law, pledge, hypothecation or other disposition, attachment, trustee process or similar process, whether legal or equitable,
upon the Option.

 

    	 

    	 

    

 

8.
No Special Employment Rights. Neither the granting of the Option nor its exercise shall be construed to confer upon the
Grantee any right with respect to the continuation of his or her employment by the Company (or any subsidiary of the Company)
or interfere in any way with the right of the Company (or any subsidiary of the Company), subject to the terms of any separate
employment agreement to the contrary, at any time to terminate such employment or to increase or decrease the compensation of
the Grantee from the rate in existence as of the date hereof.

 

9.
Tax Consequences. (a) All tax consequences under any applicable law which may arise from the grant of this Option or the
exercise thereof, the sale or disposition of any Optioned Shares granted hereunder or issued upon exercise of this Option or from
any other action of the Grantee in connection with the foregoing shall be borne and paid solely by the Grantee, and the Grantee
shall indemnify the Company, and its Subsidiary Corporation and Affiliates, and shall hold them harmless against and from any
liability for any such tax or penalty, interest or indexation thereon. The Grantee agrees to, and undertakes to comply with, any
ruling, settlement, closing agreement or other similar agreement or arrangement with any tax authority in connection with the
foregoing which is approved by the Company. The Grantee is advised to consult with a tax advisor with respect to the tax consequences
of receiving or exercising this Option. The Company does not assume any responsibility to advise the Grantee on such matters,
which shall remain solely the responsibility of the Grantee.

 

(b)
The Grantee shall notify the Company in writing promptly and in any event within ten (10) days after the date on which the Grantee
first obtains knowledge of any tax bureau inquiry, audit, assertion, determination, investigation, or question relating in any
manner to the Option granted or received hereunder or Optioned Shares issued thereunder and shall continuously inform the Company
of any developments, proceedings, discussions and negotiations relating to such matter, and shall allow the Company and its representatives
to participate in any proceedings and discussions concerning such matters. Upon request, the Grantee shall provide to the Company
any information or document relating to any matter described in the preceding sentence, which the Company, in its discretion,
requires.

 

(c)
To the extent a 102 Option Award is designated above, you declare and acknowledge: (i) that you fully understand that Section
102 of the Israeli Income Tax Ordinance and the rules and regulations enacted thereunder apply to the Options specified in this
Agreement and to you; and (ii) that you understand the provisions of Section 102, the tax track chosen and the implications thereof.
With respect to Options granted under Section 102, the terms of such Options shall also be subject to the terms of the Trust Agreement
made between the Company and the Trustee for the benefit of the Grantee, as well as the requirements of the Israeli Income Tax
Commissioner. The grant of Options hereunder is further conditioned upon the Grantee signing all documents requested by the Company
or the Trustee, in accordance with and under the Trust Agreement. A copy of the Trust Agreement is available for the Grantee’s
review, during normal working hours, at the Company’s offices.

 

10.
No Rights of Stockholder. The Grantee shall not be deemed for any purpose to be a stockholder of the Company with respect
to the Option except to the extent that the Option shall have been exercised with respect thereto and, in addition, a stock certificate
shall have been issued theretofore and delivered to the Grantee.

 

    	 

    	 

    

 

11.
Amendment. In addition to and subject to the terms and conditions of the Plan, the Board or a committee appointed by the
Board to administer the Plan (the “Committee”), whichever shall then have authority to administer the Plan, may amend
this Agreement with the consent of the Grantee when and subject to such conditions as are deemed to be in the best interests of
the Company and in accordance with the purposes of the Plan.

 

12.
Notices. Any communication or notice required or permitted to be given hereunder shall be in writing, and, if to the Company,
to its principal place of business, attention: Secretary, and, if to the Grantee, to the address as appearing on the records of
the Company. Such communication or notice shall be deemed given if and when (a) properly addressed and posted by registered or
certified mail, postage prepaid, or (b) delivered by hand.

 

13.
Incorporation of Plan by Reference. The Option is granted pursuant to the terms of the Plan, the terms of which are incorporated
herein by reference, and the Option shall in all respects be interpreted in accordance with the Plan. In the event of any inconsistency
between the Plan and this Agreement, the Plan shall govern. The Board or the Committee, whichever shall then have authority to
administer the Plan, shall interpret and construe the Plan and this Agreement, and their interpretations and determinations shall
be conclusive and binding upon the parties hereto and any other person claiming an interest hereunder, with respect to any issue
arising hereunder or thereunder.

 

14.
Acknowledgement. The Grantee acknowledges receipt of the copy of the Plan attached hereto as Exhibit A.

 

15.
Governing Law. The validity, construction and interpretation of this Agreement shall be governed by and determined in accordance
with the laws of the State of Delaware.

 

[SIGNATURES
ON NEXT PAGE]

 

    	 

    	 

    

 

IN
WITNESS WHEREOF, the undersigned have executed this Agreement as of the date above written.

 

	 	MICROBOT
    MEDICAL INC.
	 	 	 
	 	By:	 
	 	Name:	           
	 	Title:	 
	 	 	 
	 	GRANTEE:
	 	 	 
	 	Name:	 

 

    	 

    	 

    

 

Exhibit
A

 

2017
Equity Incentive PlanMICROBOT
MEDICAL LTD.

 

102
CAPITAL GAINS TRACK AWARD AGREEMENT

 

2015
STOCK OPTION PLAN

 

 

By
and between

 

Microbot
Medical Ltd.

(hereinafter: the “Company”)

 

and

 

[__]

Israel
ID# [__]

(hereinafter:
the “Participant”)

 

	WHEREAS:	 	The
    Participant is an Employee as defined in the Company’s 2015 Stock Option Plan (the “Plan”); and
	 	 	 
	WHEREAS:	 	The
    Company desires to grant the Participant options to purchase Shares in the Company, and the Participant is interested in receiving
    the aforesaid options, all in accordance with and subject to the Plan and the provisions of this award agreement and any appendix
    thereto (the “Award Agreement”), and their intention is that the provisions of Section l02 of the Israeli
    Income Tax Ordinance (New Version) 1961 (the “Ordinance”), as amended and any regulations, rules, orders
    or procedures promulgated there under, including tax rules (Preferential Tax Treatment regarding Issuance of Shares to Employees),
    2003 (“Section 102”), relating to the allocation of options in the capital gain track, shall apply to the
    options granted; and
	 	 	 
	WHEREAS:	 	The
    Participant has read all of the provisions and the terms of the Plan and this Award Agreement, and wishes to be bound by them
    and desires that they apply to the options which shall be granted to him hereunder.

 

NOW
THEREFORE IT IS AGREED AS FOLLOWS:

 

	1.	Preamble
    and definitions

 

	 	1.1.	The
    Preamble to this Award Agreement constitutes an integral part hereof.
	 	 	 
	 	1.2.	Unless
    the context otherwise requires, terms used herein and in the appendix to this Award Agreement shall have the same meaning
    set forth under the Plan.

 

    	 

    	 

    

 

	2.	Application
    of the Provisions of the Plan

 

	 	2.1.	The
    Participant hereby declares that he has carefully read the Plan and that he acknowledges and agrees to all of the provisions,
    conditions, limitations, authorizations, declarations and commitments included therein.
	 	 	 
	 	2.2.	The
    Participant declares and agrees that this Award Agreement and the Plan prevail over any previous agreement, arrangement and/or
    understanding, whether written or oral between the Participant and the Company, or the officers and/or directors and/or the
    shareholders thereof with respect to the matters herein included, and with respect to options or other securities for the
    purchase of shares in the Company which have not yet been actually issued or granted (with the exception of options that are
    planned to be granted under another approved stock option plan which was adopted by the Company), and that any agreement,
    arrangement and/or understanding as aforesaid are null and void and of no further force or effect.
	 	 	 
	 	2.3.	All
    of the provisions, conditions, limitations and declarations included and specified in the Plan, as the same shall be amended
    from time to time, are hereby incorporated herein by reference and constitute an integral part of this Award Agreement and
    of the Participant’s commitments hereunder. Except and to the extent otherwise expressly provided herein, nothing in
    this Award Agreement or in the provisions hereof shall derogate from anything contained in the Plan.
	 	 	 
	 	2.4.	The
    Participant declares, covenants and agrees that the provisions of Section 102, as the same shall be amended from time to time,
    and the trust agreement between the Company and the Trustee (the “Trust Agreement”), are fully binding
    on the Participant, and shall prevail in case of contradiction, over any other provision in the Award Agreement or in the
    Plan. Further, the Participant agrees to execute any and all documents which the Company or the Trustee may reasonably determine
    to be necessary in order to comply with the Ordinance and, particularly, the rules.
	 	 	 
	 	2.5.	The
    Participant declares and agrees that he is obligated not to make any disposition of the Awards or the Shares until the end
    of the Required Holding Period.
	 	 	 
	 	2.6.	A
    copy of the Plan is attached hereto and constitutes an integral part hereof.

 

    	 	2	 

    	 

    

 

	3.	Grant
    of Options

 

	 	3.1.	The
    Company hereby grants the Participant [__] options to purchase [__] Ordinary Shares of, par value NIS 0.001
    each (hereinafter - the -Options” and the “Award Shares”, respectively) as 102 Capital Gains Track
    Grant, all subject to the conditions of the Plan, at an exercise price per Option equals to the par value of the Award Shares
    (the “Exercise Price”).
	 	 	 
	 	3.2.	The
    Options have been or shall be following the date hereof issued to the Trustee on behalf of the Participant with the effective
    date for purposes of this Award Agreement and the Options Awarded pursuant thereto, under the Plan being the date on which
    such Options are allocated to the Trustee (“Effective Date”).
	 	 	 
	 	3.3.	The
    Participant is aware that the Company intends to issue additional Shares or other securities in the future to various entities
    and individuals, as the Company in its sole discretion shall determine, in its sole discretion, including securities that
    may be ranked senior to the Shares.

 

	4.	Transfer
    of Options

 

The
transfer of these Options is limited as set forth in the Plan.

 

	5.	Exercise
    Price

 

Each
Option may be exercised in consideration of the payment in cash (or by any other mean as specified in the Plan) of the Exercise
Price indicated above.

 

	6.	Vesting
    of Options

 

All
Options are fully vested.

 

	7.	Method
    of Exercise

 

	 	7.1.	The
    Options, or any part thereof, shall be exercised by the Participant by signing and returning to the Company and the Trustee
    (if such Options are held by the Trustee), at their principal offices, a notice of exercise in such form as may be prescribed
    by the Company from time to time (the “Notice of Exercise”), together with full payment of the Exercise
    Price.
	 	 	 
	 	7.2.	In
    order to issue Award Shares upon the exercise of any of the Options, the Participant hereby agrees to sign any and all documents
    required by the Company’s management and/or the Trustee and/or any law and/or the Company’s Articles of Association.

 

    	 	3	 

    	 

    

 

	 	7.3.	After
    a Notice of Exercise has been delivered to the Company (and/or the Trustee if relevant), it may not be rescinded or revised
    by the Participant. Subsequent to the Company’s receipt of a Notice of Exercise, together with the payment of the Exercise
    Price and certification that the taxes referred to in Section 17 below, have been or will be paid by the Participant, the
    Award Shares issuable upon the exercise of the Options shall be issued to the Participant, or the Trustee pursuant the provision
    of Section 102.
	 	 	 
	 	7.4.	The
    Trustee will transfer the Shares to the Participant upon demand but in no event before all taxes due, if any, have been fully
    paid. By signing this Award Agreement, the Participant authorizes the Trustee not to transfer any Award Shares prior to the
    full payment of all applicable taxes.

 

	8.	Restrictions
    on Transfer

 

	 	8.1.	Securities
    Law Restrictions. Regardless of whether the offering and sale of Award Shares under the Plan have been registered under the
    U.S. Securities Act of 1933, as amended, and the rules and regulations promulgated thereunder (the “Securities Act”)
    or have been registered or qualified under the securities laws of any state or other laws of any other jurisdiction, the Company
    at its discretion may impose restrictions upon the sale, pledge or other transfer of such Award Shares (including the placement
    of appropriate legends on stock certificates or the imposition of stop-transfer instructions) if, in the judgment of the Company,
    such restrictions are necessary or desirable in order to achieve compliance with the Securities Act, the securities laws of
    any state or any other law.
	 	 	 
	 	8.2.	Market
    Stand-Off. In connection with any underwritten public offering by the Company of its equity securities pursuant to an effective
    registration statement filed under the Securities Act or equivalent law in another jurisdiction, including the Company’s
    initial public offering of its shares, the Participant shall not directly or indirectly sell, make any short sale of, loan,
    hypothecate, pledge, offer, grant or sell any Option or other contract for the purchase of, purchase any Option or other contract
    for the sale of, or otherwise dispose of or transfer, or agree to engage in any of the foregoing transactions with respect
    to, any Award Shares acquired under this Award Agreement without the prior written consent of the Company or its underwriters.
    Such restriction (the “Market Stand-Off”) shall be in effect for such period of time following the date
    of the final prospectus for the offering as may be requested by the Company or such underwriters. In the event of the declaration
    of a stock dividend, a spin-off, a stock split, an adjustment in conversion ratio, a recapitalization or a similar transaction
    affecting the Company’s outstanding securities without receipt of consideration, in accordance with the provisions of
    the Plan, any new, substituted or additional securities which are by reason of such transaction distributed with respect to
    any Award Shares subject to the Market Stand-Off, or into which such Award Shares thereby become convertible, shall immediately
    be subject to the Market Stand-Off. In order to enforce the Market Stand-Off, the Company may impose stop-transfer instructions
    with respect to the Award Shares acquired under this Award Agreement until the end of the applicable stand-off period. The
    Company’s underwriters shall be beneficiaries of the agreement set forth in this Section 8.2. This Section 8.2 shall
    not apply to Award Shares registered in the public offering under the Securities Act or equivalent law in another jurisdiction.

 

    	 	4	 

    	 

    

 

	9.	No
    Obligation to Exercise Options

 

The
Award and acceptance of these Options imposes no obligation on the Participant to exercise them.

 

	10.	No
    Obligation to Continue Employment with the Participant

 

Neither
the Plan, this Award Agreement, nor the grant of these Options imposes any obligation on the Company to continue the employment
of the Participant.

 

	11.	No
    Rights as Stockholder until Exercise

 

The
Participant shall have no right as a stockholder with respect to the Shares until such time as the Participant has exercised Options
by delivering a Notice of Exercise and has paid in full the Exercise Price for the Award Shares so exercised in accordance with
the foregoing.

 

	12.	Voting
    Proxy and Automatic Conversion

 

	 	12.1.	Notwithstanding
    Section 11 above and only after such time as the Awards or the Shares are discharged from the Trustee, until the consummation
    of the initial public offering of the Company’s Shares, the right to vote any Shares acquired hereunder pursuant to
    the Options granted under this Award Agreement, if any, shall be given by the Participant, pursuant to an irrevocable proxy
    to the person or persons designated by the Board (the “Proxy”). Upon signing this Award Agreement and as
    a condition to the grant of any Options hereunder, the Participant shall sign the irrevocable proxy attached to this Award
    Agreement as Appendix B. The Shares shall be voted by the Proxy in the same proportion as the result of the shareholders
    vote (as voted by the shareholders without taking in consideration the Shares issued upon exercise of Options granted under
    this Award Agreement).
	 	 	 
	 	12.2.	In
    case of a merger and/or a transaction pursuant to which all shares of Company’s shareholders are converted into securities
    of another corporation, as approved by Company’s Board of Directors, all Options may be automatically converted into
    securities of such other corporation, if and to the extent resolved by Company’s Board of Directors. Upon request, Participant
    shall sign any documents, instrument or statement required to cause the execution, delivery and performance of such conversion.
    Failure of Participant to comply with its

 

    	 	5	 

    	 

    

 

	13.	Governing
    Law

 

These
Options will be governed by law as set forth in the Plan.

 

	14.	Jurisdiction

 

Subject
to the provisions of Section 15 below, any disputes arising from these Options shall be resolved as set forth in the Plan.

 

	15.	Disputes

 

As
a condition of the granting of the Options, the Participant and the Participant’s successors and assignees agree that any
dispute or disagreement which may arise hereunder or as a result of this Award Agreement shall be settled by the Administrator
(as defined in the Plan), in its sole discretion and judgment and that any such determination and any interpretation by the Administrator
of the terms of this Award Agreement shall be final, binding and conclusive for all intents and purposes.

 

	16.	Terms
    and Expiration

 

These
Options, unless terminated earlier under the provisions of the Plan, shall expire in all events following the expiration of ten
(10) years as of the date of this Agreement.

 

	17.	Taxes

 

	 	17.1.	The
    aforementioned Award and the Shares will be held by the Trustee in trust on behalf of the Participant for the Required Holding
    Period, as defined under the Plan, subject to the terms set in Section 102. In accordance with Section 102, the Participant
    is prohibited from selling the Awards or the Award shares, until the end of the Required Holding Period.
	 	 	 
	 	17.2.	All
    rights related to the Awards or the Shares will be held by the Trustee until the end of the Required Holding Period, including
    bonus shares, and will be subject to the provisions of Section 102 applicable to the Award.
	 	 	 
	 	17.3.	Any
    and all taxes, fees and other liabilities (as may apply from time to time) in connection with the grant and/or exercise of
    the Options and the sale of Shares issued upon the exercise of the Options, will be solely borne by the Participant and he
    will be solely liable for all such taxes, fees and other liabilities. Furthermore, the Participant shall agree to indemnify
    the Company and the Trustee and hold them harmless against and from any and all liability for any such tax or interest or
    penalty thereon.

 

    	 	6	 

    	 

    

 

		17.4.	The
                                         Participant acknowledges that the receipt of the Options and the acquisition of the Shares
                                         to be issued upon the exercise of the Options may result in tax consequences. The description
                                         set forth in the Plan relating to the payment of tax does not purport to be a full and
                                         complete description of the Participant’s tax obligations under the law.

 

		17.5.	In
                                         the event that the Company or the Trustee determines that it is required to withhold
                                         any tax as a result of the exercise of these Options, the Participant, as a condition
                                         to the exercise of these Options, shall make arrangements satisfactory to the Company
                                         or the Trustee to enable them to satisfy all withholding requirements. The Participant
                                         shall also make arrangements satisfactory to the Company to enable it to satisfy any
                                         withholding requirements that may arise in connection with the vesting or disposition
                                         of Award Shares purchased by exercising these Options.

 

	18.	Miscellaneous
    Provisions

 

	 	18.1.	Each
    party to this Award Agreement agrees to perform any and all further acts and to execute and deliver any documents that may
    reasonably be necessary to carry out the provisions of this Award Agreement.
	 	 	 
	 	18.2.	The
    Participant agrees and acknowledges that the terms and conditions of this Award Agreement, including without limitation the
    number of Award Shares for which Options have been granted, are confidential. The Participant agrees that he will not disclose
    these terms and conditions to any third party, except to the Participant’s financial or legal advisors, or family members,
    unless such disclosure is required by law.
	 	 	 
	 	18.3.	Any
    notice or other communication under this Award Agreement must be in writing and shall be effective upon delivery by hand,
    or three (3) business days after deposit in the mail, postage prepaid, certified or registered, and addressed to the Company
    or to the Participant at the corresponding address as written in the preamble to this Award Agreement; provided, however,
    that any Notice of Exercise or payment to the Company under section 7 of this Award Agreement shall be effective only upon
    actual receipt by the Company at the address above. Each party shall be obligated to notify the other in writing of any change
    in that party’s address. Notice of change of address shall be effective only when done in accordance with this Section.

 

    	 	7	 

    	 

    

 

IN
WITNESS WHEREOF the parties have signed and delivered this Award Agreement.

 

 

	Microbot
    Medical Ltd.	 	Participant

 

    	 	8	 

    	 

    

 

APPENDIX
A

 

2015
STOCK OPTION PLAN

 

    	 	9	 

    	 

    

 

APPENDIX
B

 

IRREVOCABLE
PROXY

 

Only
after such time as the Awards or the Shares are discharged from the Trustee I, the undersigned, authorize, irrevocably, the Chairman
of the Board of Directors or his designee of Microbot Medical Ltd. (the “Company”), as may be in office
from time to time, to represent me at any and all general meetings of the Company (whether ordinary, extraordinary or otherwise),
and to vote thereat on any and all matters the same number of Shares of the Company (as I may receive pursuant to the exercise
of Options granted under any of the Company’s Stock Option Plan(s); “Plan”) as I would be entitled to
vote if then personally present. My shares shall be voted by him in the same proportion as the result of the shareholders vote
(as voted by the shareholders without taking in consideration the Shares issued upon exercise of options granted under the Plan).

 

Whereas
the rights of third parties depend on this proxy, I shall have no power to revoke it and it will also bind my heirs and successors
by operation of law.

 

This
proxy will terminate upon the consummation of the initial public offering of the Company’s Shares.

 

	 	 	 
	Name	 	 
	 	 	 
	 	 	 
	Signature	 	 

 

    	 	10

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