Form F-X - Appointment of Agent for Service of Process and Undertaking
September 14 2023 - 4:51PM
Edgar (US Regulatory)
UNITED
STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON,
D.C. 20549
FORM
F-X
APPOINTMENT
OF AGENT FOR SERVICE OF PROCESS
AND
UNDERTAKING
A. |
Name
of issuer or person filing (“Filer”): |
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FORESIGHT
AUTONOMOUS HOLDINGS LTD. |
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B. |
(1)
This is an (check one): |
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☒ |
original
filing for the Filer. |
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☐ |
amended
filing for the Filer. |
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C. |
Identify
the filing in conjunction with which this Form is being filed: |
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Name
of registrant: |
FORESIGHT
AUTONOMOUS HOLDINGS LTD. |
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Form
type: |
Tender
Offer/Rights Offering Notification Form
on
Form CB (the “Form CB”) |
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File
Number (if known): |
005-90384 |
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Filed
by: |
FORESIGHT
AUTONOMOUS HOLDINGS LTD. |
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Date
Filed (if filed concurrently, so indicate): |
September
14, 2023 (concurrent herewith) |
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D. |
The
Filer is incorporated or organized under the laws of: |
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Israel |
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and
has its principal place of business at: |
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7
Golda Meir
Ness
Ziona 7403650, Israel |
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E. |
The
Filer designates and appoints Puglisi & Associates, (“Agent”) located at: |
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850
Library Ave., Suite 204
Newark,
DE 19711
(302)-738-6680 |
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as
the agent of the Filer upon whom may be served any process, pleadings, subpoenas, or other papers in: |
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(a) |
Any
investigation or administrative proceeding conducted by the Commission; and |
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(b) |
Any
civil suit or action brought against the Filer or to which the Filer has been joined as defendant or respondent, in any appropriate
court in any place subject to the jurisdiction of any state or of the United States or of any of its territories or possessions or
of the District of Columbia, where the investigation, proceeding or cause of action arises out of or relates to or concerns any offering
made or purported to be made in connection with the securities described by the Filer in the Form CB filed on September 14,
2023 or any purchases or sales of any security in connection therewith. Filer stipulates and agrees that any such civil suit or action
or administrative proceeding may be commenced by the service of process upon, and that service of an administrative subpoena shall
be effected by service upon such agent for service of process, and that service as aforesaid shall be taken and held in all courts
and administrative tribunals to be valid and binding as if personal service thereof had been made. |
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F. |
The
Filer stipulates and agrees to appoint a successor agent for service of process and file an amended Form F-X if the Filer discharges
the Agent or the Agent is unwilling or unable to accept service on behalf of the Filer at any time until six years have elapsed following
the effective date of the latest amendment to the Form CB.
The
Filer further undertakes to advise the Commission promptly of any change to the Agent’s name or address during the applicable
period by amendment of this Form, referencing the file number of the relevant form in conjunction with which the amendment is being
filed. |
The
Filer certifies that it has duly caused this power of attorney, consent, stipulation and agreement to be signed on its behalf by the
undersigned, thereunto duly authorized, in the city of Ness Ziona, country of Israel, on September 14, 2023.
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Filer:
FORESIGHT AUTONOMOUS HOLDINGS LTD. |
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By: |
/s/
Eli Yoresh |
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Name:
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Eli
Yoresh |
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Title: |
Chief
Financial Officer |
This
statement has been signed by the following person in the capacity indicated on September 14, 2023.
PUGLISI & ASSOCIATES |
(Agent for service of process for Foresight Autonomous Holdings Ltd.) |
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By: |
/s/
Puglisi & Associates |
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Puglisi
& Associates |
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