Access Plans USA, Inc. Common Stock Certificate Form

Summary

This document is a form of stock certificate for Access Plans USA, Inc., representing ownership of common stock in the company. It outlines that the corporation can issue multiple classes and series of stock, and provides information on how shareholders can request details about the rights and preferences of each class or series. The certificate also includes instructions for transferring shares and requires signatures to be guaranteed by an eligible financial institution. The document is intended for use by shareholders and transfer agents in recording and transferring stock ownership.

EX-4.1 4 d43953exv4w1.htm FORM OF CERTIFICATE OF THE COMMON STOCK exv4w1

Exhibit 704.01.01

STOCK CERTIFICATE

CUSIP: 00433N 10 6

ACCESS PLANS USA, INC.

The Corporation is authorized to issue more than one class of stock and more than one series of preferred stock. The Corporation will furnish upon request and without charge a full statement of the designations and the powers, preferences and rights, and the qualifications, limitations or restrictions of the shares of each class of stock authorized to be issued by it, and the variations in the relative rights and preferences between the shares of each series of any preferred class so far as the same have been fixed and determined, and the authority of the Board of Directors to fix and determine the relative rights and preferences of subsequent series of any preferred class. Such request may be made to the Secretary of the Corporation, or to the Transfer Agent.

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:


TEN COM	-	as tenants in common
TEN ENT	-	as tenants by the entireties
JT TEN	-	as joint tenants with right of survivorship and not as tenants in common


UNIF GIFT MIN ACT-			Custodian

		(Cust)		(Minor)
	Under Uniform Gifts to Minors
	Act

		(State)
UNIF TRNFR MIN ACT-			Custodian

		(Cust)		(Minor)
	Under Uniform Transfers to Minors
	Act

		(State)

Additional abbreviations may also be used though not in the above list.

FOR VALUE RECEIVED, hereby sell, assign and transfer unto


PLEASE lNSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE




(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE OF ASSIGNEE)








		Shares

of the Common Stock represented by the within Certificate, and do hereby irrevocably constitute and appoint

	attorney-in-fact

to transfer the said stock on the books of the within-named Corporation, with full power of substitution in the premises.


Dated







	NOTICE:	THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATSOEVER.

Signature(s) Guaranteed:


By

		THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM) PURSUANT TO S.E.C. RULE 17Ad-15.