Stock Certificate Assignment and Transfer Form for Common Stock

Summary

This document is a standard assignment and transfer form used to transfer ownership of common stock represented by a physical certificate. The current holder authorizes the sale, assignment, and transfer of shares to a new owner, whose details must be provided. The form requires a signature guarantee from an eligible financial institution and must match the name on the certificate exactly. It also includes standard legal abbreviations for different forms of ownership. This form is typically used in connection with the transfer of stock certificates between parties.

EX-4.5 6 w77668a3exv4w5.htm EX-4.5 exv4w5

Exhibit 4.5

CUSIP 099502 10 6

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)

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 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,

SIGNATURE(S) GUARANTEED:

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.



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.