COMMON STOCK

Contract Categories: Business Finance - Stock Agreements
EX-4.1 3 a2162566zex-4_1.htm EXHIBIT 4.1

Exhibit 4.1

 

 

COMMON STOCK

Intarcia
Therapeutics, Inc.

COMMON STOCK

ITCA

THIS CERTIFICATE IS TRANSFERABLE IN

CANTON, MA, JERSEY CITY, NJ

OR NEW YORK, NY

 

SEE REVERSE FOR

CERTAIN DEFINITIONS

CUSIP 45820N 10 2

 

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

 

This Certifies that

 

 

 

 

is the record holder of

 

FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $.001 PAR VALUE, OF

 

INTARCIA THERAPEUTICS, INC.

 

transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon the surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar.

 

                WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers.

 

Dated:

 

SECRETARY

PRESIDENT

/s/ James M. Ahlers

/s/ K. Alice Leung

 

 

COUNTERSIGNED AND REGISTERED

                EQUISERVE TRUST COMPANY, N.A.

                                TRANSFER AGENT AND REGISTRAR

 

                                                /s/ Stephen Cesso

                                                AUTHORIZED SIGNATURE

 

 

[SEAL]

 

 



 

INTARCIA THERAPEUTICS, 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 requests shall be made to the Corporations’s Secretary at the principal office of the Corporation.

 

                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)

 

 

 

 

 

 under Uniform Transfers

 

 

(Minor)

 

 

to Minors Act

 

 

 

(State)

 

Additional abbreviations may also be used though not in the above list.

 

FOR VALUE RECEIVED, ____________ hereby sell, assign and transfer(s) 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 Common Stock represented by the within Certificate, and do(es) 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 ______________________________________

 

NOTICE: THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH

THE NAME(s) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY

PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE

WHATEVER.

 

 

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 S.E.C. RULE 17Ad-15.

 

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.