Stock Certificate Assignment and Transfer Form
This document is a standard form used to transfer ownership of shares of capital stock from one party to another. The current shareholder authorizes the sale, assignment, and transfer of shares to a new owner, whose details must be provided. The form requires the signature of the current shareholder, which must match the name on the certificate and be guaranteed by an eligible financial institution. The appointed attorney is authorized to record the transfer on the corporation's books. The form also explains common abbreviations related to ownership types.
Exhibit 4.1
The following abbreviation, 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 night of survivorship and not as tenants in common | 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 capital 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,____________________
| 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. |
| SIGNATURE(S) GUARANTEED: | |
| 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. |
The following abbreviation, 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 night of survivorship and not as tenants in common | 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 capital 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,____________________
| 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. |
| SIGNATURE(S) GUARANTEED: | |
| 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. |
