Specimen Common Stock Certificate Assignment Form for Derma Corporation
This document is a specimen form used to transfer ownership of common stock in Derma Corporation. It allows the current holder to sell, assign, and transfer shares to another party by providing the assignee’s details and authorizing an attorney to complete the transfer on the corporation’s records. The form requires the signature of the current holder, which must match the name on the certificate and be guaranteed by an eligible financial institution. A transfer fee applies. This form is typically used in connection with the sale or transfer of stock certificates.
Exhibit 4.1
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 the right of | Act ......................... | ||
| survivorship and not as tenants | (State) | |||
| in common | ||||
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 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 |
| X |
THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THIS CERTIFICATE. THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions).
SIGNATURE GUARANTEED:
TRANSFER FEE WILL APPLY
