HEMOSENSE, INC.

EX-4.1 3 dex41.htm SPECIMEN COMMON STOCK CERTIFICATE Prepared by R.R. Donnelley Financial -- Specimen Common Stock Certificate

Exhibit 4.1

 

 

HEMOSENSE, INC.

 

THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR RIGHTS. SUCH REQUEST MUST BE MADE TO THE CORPORATION’S SECRETARY AT THE PRINCIPAL EXECUTIVE OFFICE OF THE CORPORATION.

 

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

 

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 Act_____________

         (State)                          

JT TEN

  

- as joint tenants with right of survivorship

   

UNIF TRF MIN ACT ___________Custodian (until age____)_______

   

  and not as tenants in common

   

                                         (Cust)                                                     (Minor)

        

                    under Uniform Transfers to Minors 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 POSTAL ZIP CODE, OF ASSIGNEE)

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                         Shares

of the Common 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:                                      20        

      

Signature:

    

Signature(s) Guaranteed:

      

Signature:

     

By:

                

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(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