Signature(s)Guaranteed: Medallion Guarantee Stamp

EX-4.1 4 d681748dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

Common stock

This certificate is transferable in canton, ma, jersey city, nj and college station, tx

common stock

par value $0.001

certificate number zq00000000

this certifies that mr. sample & mrs. sample & mr. sample & mrs. sample is the owner of ***zero hundred thousand zero hundred and zero***

intersect ent, inc. incorporated under the laws of the state of delaware

fully-paid and non-assessable shares of common stock of

intersect ent, inc. (hereinafter called the “company”), transferable on the books of the company in person or by duly authorized attorney, upon surrender of this certificate properly endorsed. this certificate and the shares represented hereby, are issued and shall be held subject to all of the provisions of the certificate of incorporation, as amended, and the bylaws, as amended, of the company (copies of which are on file with the company and with the transfer agent), to all of which each holder, by acceptance hereof, assents. this certificate is not valid unless countersigned and registered by the transfer agent and registrar.

witness the facsimile seal of the company and the facsimile signatures of its duly authorized officers

dated dd-mmm-yyyy countersigned and registered: computershare trust company, n.a. transfer agent and registrar, president and chief executive officer secretary security instructions on reverse by authorized signature

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

INTERSECT ENT, INC.

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	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 and not as tenants in common	UNIF TRF MIN ACT	-……..............……… Custodian (until age.................................... )
			(Cust)
			........................under Uniform Transfers to Minors Act ...................
			(Minor) (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		Shares

		Attorney
to transfer the said stock on the books of the within-named Company with full power of substitution in the premises.		Attorney


Dated: 20		Signature(s) Guaranteed: Medallion Guarantee Stamp 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:
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.