Converse Inc. Common Stock Certificate

Summary

This document certifies that the named holder owns fully paid shares of common stock in Converse Inc., a Delaware corporation. The certificate allows the holder to transfer ownership by proper endorsement and is subject to the corporation's Certificate of Incorporation and its amendments. The certificate is only valid when countersigned by the transfer agent. Stockholders may request information about the rights and preferences of each class of stock. The document also includes instructions for transferring shares and requirements for signature guarantees.

EX-4.1 5 b44904a2exv4w1.txt CERTIFICATE OF STOCK EXHIBIT 4.1 [CONVERSE LOGO] CONVERSE INC. INCORPORATED UNDER THE LAWS THIS CERTIFICATE IS TRANSFERABLE IN OF THE STATE OF DELAWARE CANTON, MA, JERSEY CITY, NJ OR NEW YORK, NY This Is To Certify that CUSIP [illegible] is the owner of FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK, PAR VALUE $.01 PER SHARE, OF CONVERSE INC. (hereinafter called the "Corporation"), transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney, upon the surrender of this certificate properly endorsed. This certificate and the shares represented hereby are issued and shall be held subject to all of the provisions of the Certificate of Incorporation of the Corporation, and all amendments thereto, to all of which the holder of this certificate assents by his acceptance hereof. This certificate is not valid unless countersigned by the Transfer Agent. WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. [CONVERSE INC. CORPORATE SEAL 2001 DELAWARE] Dated: (SIGNATURE TO COME) (SIGNATURE TO COME) CHIEF EXECUTIVE OFFICER EXECUTIVE CHAIRMAN OF THE BOARD COUNTERSIGNED AND REGISTERED: EQUISERVE TRUST COMPANY, N.A. TRANSFER AGENT AND REGISTRAR BY [ILLEGIBLE] AUTHORIZED SIGNATURE The Corporation will furnish without charge to each stockholder who so requests a statement of the designations, powers, preferences and relative participating, optional or other special rights of each class of stock or series thereof of the Corporation and the qualifications, limitations or restrictions of such preferences and/or rights. Such request may be made to the Corporation or the Transfer Agent. 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 JT TEN -as joint tenants with right of survivorship and not as Act______________________ tenants in common (State) Additional abbreviations may also be used though not in the above list. For value received, the undersigned hereby sells, assigns and transfers 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.