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

EX-4.1 4 d892345dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

CHIASMA
CI
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE
CUSIP 16706W 10 2
SEE REVERSE FOR CERTAIN DEFINITIONS
is the record holder of
fully paid and nonassessable shares of common stock par value $0.01 par value per share, of
CHIASMA, INC.
transferable on the books of the corporation in person or by duly authorized attorney upon surrender of this certificate properly endorsed. this certificate is not valid until countersigned by the transfer agent and registered by the registrar.
witness the facsimile seal of the corporation and the facsimile signatures of its duly authorized officers.
dated:
countersigned and registered: american stock transfer trust& company, llc
(Brooklyn, ny) transfer agent and registrar
by:
authorized signature
president & chief executive officer
secretary

The Corporation shall furnish without charge to each stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock of the Corporation or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights. Such requests shall be made to the Corporation’s Secretary at the principal office of the Corporation.

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

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)
COM PROP   –    as community property   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(s), assign(s) and transfer(s) 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 capital stock represented by 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 the substitution in the premises.

Dated                                                                                             

 

       

 

       

 

Signature(s) Guaranteed:

         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 WHATSOEVER.

 

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. GUARANTEES BY A NOTARY PUBLIC ARE NOT ACCEPTABLE. SIGNATURE GUARANTEES MUST NOT BE DATED.