Form of Certificate of the Common Stock

Contract Categories: Business Finance - Stock Agreements
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.