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

EX-4.1 5 dex41.htm FORM OF COMMON STOCK CERTIFICATE OF AFFINION GROUP HOLDINGS, INC. Form of Common Stock Certificate of Affinion Group Holdings, Inc.

Exhibit 4.1

 

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       UNIF GIFT MIN ACT    —                         Custodian                      
    TEN ENT    —    as tenants by the entireties                   (Cust)                           (Minor)
    JT TEN    —    as joint tenants with right of             under Uniform Gifts to Minors
      survivorship and not as tenants             Act                                                        
      in common                                         (State)
            UNIF TRF MIN ACT    —                 Custodian (until age              )
                    (Cust)
                                     under Uniform Transfers
                      (Minor)
                  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 INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE

 

 
 

 

                                                                                                                                                                                                                             

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

                                                                                                                                                                                                                             

                                                                                                                                                                                                                             

                                                                                                                                                                                                                Shares

of the common stock represented by the within Certificate, and do hereby irrevocably constitute and appoint
                                                                                                                                                                                                         Attorney
to transfer the said stock on the books of the within named Corporation with full power of substitution in the premises.

Dated                     

 

   X   

 

   X   

 

   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 WHATEVER.

 

Signature(s) Guaranteed   
By   

 

   
THE SIGNATURE(S) SHOULD 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.   

KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, MUTILATED OR DESTROYED, THE CORPORATION MAY REQUIRE A BOND OF INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE.