Form of Common Stock Certificate
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 right of |
under Uniform Gifts to Minors Act (State) | ||||||
TTEE | trustee under Agreement dated |
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 NUMBERS OF ASSIGNEE | ||
PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE. | ||
Shares | ||||||
of the common stock represented by this certificate and do hereby irrevocably constitutes 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
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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 whatsoever. |
SIGNATURE GUARANTEED:
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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. |