EX-4.1: SPECIMEN COMMON STOCK CERTIFICATE

EX-4.1 2 g99350a3exv4w1.htm EX-4.1: SPECIMEN COMMON STOCK CERTIFICATE exv4w1
 

Exhibit 4.1

 

DELEK US HOLDINGS, INC.
     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 requests shall be made to the Corporation’s Secretary 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 commn       UNIF GIFT MIN ACT —                                              Custodian                                           
TEN ENT   —   as tenants by the entireties           (Cust)
       (Minor)
JT TEN   —   as joint tenants with right           under Uniform Gifts to Minors    
 
      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,                                          hereby sell, assign and transfer unto

PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE

      
      
      


 
(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS 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. The signature of the person executing this power must be guaranteed by an Eligible Guarantor Institution such as a Commercial Bank, Trust Company, Securities Broker/Dealer, Credit Union, or a Savings Association participating in a Medallion program approved by the Securities Transfer Association, Inc.


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.
      


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