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*
Li Jiewei

(Last) (First) (Middle)
BAK INDUSTRIAL PARK, MEIGUI STREET
HUAYUANKOU ECONOMIC ZONE

(Street)
DALIAN F4 116450

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/22/2023
3. Issuer Name and Ticker or Trading Symbol
CBAK Energy Technology, Inc. [ CBAT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CFO
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)
Common Stock 5,000(1) D
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 Share Units (2) (2) Common Stock 5,000 (2) D
Options (3) (3) Common Stock 20,000 (3) D
Options (4) (4) Common Stock 4,000 (4) D
Explanation of Responses:
1. Representing 5,000 restricted share units granted under the Company's 2015 Equity Incentive Plan that have vested.
2. Representing 5,000 restricted share units granted under the Company's 2015 Equity Incentive Plan that will vest on December 31, 2023.
3. Representing an option to purchase 20,000 shares of common stock granted under the Company's 2015 Equity Incentive Plan, which will vest on June 30 and December 31 of 2024 and 2025 in four equal installments.
4. On November 29, 2021, the reporting person was granted an option to purchase 20,000 shares of common stock. The option vests in 10 equal semi-annual installments based on the CBAT's satisfaction of certain performance criteria for each of the fiscal year ending December 31, 2021, 2022, 2023, 2024 and 2025. The performance criteria for 2021 were met, resulting in vesting of the option as to 2,000 shares on May 30, 2022 and 2,000 shares on November 30, 2022. The performance criteria for 2022 were not met, and thus, no portion of the option was vested in 2023.
/s/ Jiewei Li 08/29/2023
** 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.