Additional abbreviations may also be used though not in the above list. For Value Received, hereby sell, assign and transfer unto

EX-4.1 5 d192955dex41.htm FORM OF COMMON STOCK CERTIFICATE Form of Common Stock Certificate

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 right of

   under Uniform Gifts to Minors

                survivorship and not as tenants

  

                in common

   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 ZIP CODE, OF ASSIGNEE)

 

 

 

 

 

   

Shares

of the 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 WHATSOEVER.

Signature(s) Guaranteed

 

By                                                                                            

   

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 SEC Rule 17Ad-15.

   

 

 

THE CORPORATION WILL FURNISH TO ANY STOCKHOLDER, UPON REQUEST AND WITHOUT CHARGE, A FULL STATEMENT OF THE DESIGNATIONS, RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF THE SHARES OF EACH CLASS AND SERIES AUTHORIZED TO BE ISSUED, SO FAR AS THE SAME HAVE BEEN DETERMINED, AND OF THE AUTHORITY, IF ANY, OF THE BOARD TO DIVIDE THE SHARES INTO CLASSES OR SERIES AND TO DETERMINE AND CHANGE THE RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF ANY CLASS OR SERIES. SUCH REQUEST MAY BE MADE TO THE SECRETARY OF THE CORPORATION OR TO THE TRANSFER AGENT NAMED ON THIS CERTIFICATE.