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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Heller Anat

(Last) (First) (Middle)
C/O MOBILEYE B.V.
HAR HOTZVIM, 13 HARTOM STREET

(Street)
JERUSALEM L3 9777513

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/26/2022
3. Issuer Name and Ticker or Trading Symbol
Mobileye Global Inc. [ MBLY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Financial 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)
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
Restricted Stock Units (2) (2) Class A Common Stock 95,238 (1) D
Restricted Stock Units (3) (3) Class A Common Stock 61,169 (1) D
Explanation of Responses:
1. Each restricted stock unit (RSU) represents the right to receive, following vesting, one share of Class A common stock of Mobileye Global Inc.
2. Unless earlier forfeited under the terms of the RSU, the RSU will vest as follows: (a) 40% of the RSUs vest and convert into common stock on the first anniversary of the grant date (which grant date is October 26, 2022), (b) 30% of the RSUs vest and convert into common stock on the second anniversary of the grant date and (c) 30% of the RSUs vest and convert into common stock on the third anniversary of the grant date. If a vesting date falls on a non-business date, the next business date shall apply.
3. Unless earlier forfeited under the terms of the RSU, 100% of the RSUs vest and convert into common stock on the six-month anniversary of the grant date (which grant date is October 26, 2022) (or next business date, if applicable).
/s/ Liz Cohen-Yerushalmi, by power of attorney 10/26/2022
** 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.