EX-4.1 Specimen cerificate for shares of common stock

EX-4.1 6 b63591a2exv4w1.htm EX-4.1 SPECIMEN CERIFICATE FOR SHARES OF COMMON STOCK exv4w1
 

Exhibit 4.1
STOCK CERTIFICATE CUSIP: 45784P101

 

INSULET CORPORATION
THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND RIGHTS, AND THE VARIATIONS IN RIGHTS, PREFERENCES AND LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIXED BY THE ARTICLES OF INCORPORATION OF THE COMPANY, AS AMENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR FUTURE SERIES. SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT. THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY SUCH 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
       
 
TEN ENT   -  
as tenants by the entireties
       
 
JT TEN   -  
as joint tenants with right of survivorship and not as tenants in common
             
UNIF GIFT MIN ACT-
                         Custodian                       
    (Cust)       (Minor)
     
under Uniform Gifts to Minors Act
                       
 
  (State)
             
UNIF TRF MIN ACT
                                              Custodian   (until age                     )                    
 
  (Cust)       (Minor)
     
under Uniform Gifts to Minors Act
                       
 
  (State)


Additional abbreviations may also be used though not in the above list.
 
PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING
NUMBER OF ASSIGNEE
     For value received,                                                               hereby sell, assign and transfer unto                                                                     
 
(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(s) Guaranteed: Medallion Guarantee Stamp
 
                
 
                    
Signature:
       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.
 
                    
Signature:
                    
         
  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.  
SECURITY INSTRUCTIONS
THIS IS WATERMARKED PAPER. DO NOT ACCEPT WITHOUT NOTING WATERMARK. HOLD TO LIGHT TO VERIFY WATERMARK.