Signature(s) Guaranteed: Medallion Guarantee Stamp

Contract Categories: Business Finance - Guarantee Agreements
EX-4.1 5 dex41.htm FORM OF COMMON STOCK CERTIFICATE Form of Common Stock Certificate

Exhibit 4.1

 

ARCA BIOPHARMA, INC.

THE CORPORATION WILL FURNISH TO ANY STOCKHOLDER, UPON REQUEST AND WITHOUT CHARGE, A STATEMENT OF THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR RIGHTS. ANY SUCH REQUEST SHOULD BE ADDRESSED TO THE SECRETARY OF THE CORPORATION AT ITS PRINCIPAL OFFICE.

 

   
    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  

 

    
          (Cust)     (Minor)    
    TEN ENT   - as tenants by the entireties     under Uniform Gifts to Minors Act  

 

    
            (State)    
    JT TEN   - as joint tenants with right of survivorship and not as tenants in common   UNIF TRF MIN ACT  

 

   Custodian (until age.    )  

 

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

 

    
            (State)    
       

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

 

    

 

 

PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE

For value received,                      hereby sell, assign and transfer unto    

 

 

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

 

Dated:  

 

   20                   

Signature(s) Guaranteed: Medallion Guarantee Stamp

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.

Signature:  

 

       
Signature:  

 

       
  Notice:   The signature to this assignment must correspond with the name as written upon the face of the certificate, in every particular, without alteration or enlargement, or any change whatever.