Stock Certificate Assignment and Transfer Form for Shareholders
This document is a stock certificate assignment and transfer form used by shareholders to sell, assign, or transfer shares of a corporation's capital stock to another party. The form requires the current shareholder to provide the new shareholder's information, including name, address, and tax identification number, and to appoint an attorney to execute the transfer on the corporation's records. The signature of the transferring shareholder must match the name on the certificate and be guaranteed by an eligible financial institution. A transfer fee applies to the transaction.
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 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 EIN / SSN AND COST BASIS OF ASSIGNEE | NAME OF REGISTERED SHAREHOLDER |
| PLEASE PRINT OR TYPEWRITE NAME(S) AND ADDRESS(ES), INCLUDING ZIP CODE, OF NEW SHAREHOLDER(S) |
| 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
