FORM OF STOCK CERTIFICATE

Contract Categories: Business Finance - Stock Agreements
EX-4.1 6 dex41.htm FORM OF COMMON STOCK CERTIFICATE Form of Common Stock Certificate

EXHIBIT 4.1

 

FORM OF STOCK CERTIFICATE

 

NUMBER

CS

  

COMMON STOCK

SHARES

THIS CERTIFICATE IS TRANSFERABLE   SEE REVERSE FOR CERTAIN DESIGNATIONS AND A
IN [                                                                     ].   STATEMENT AS TO THE RIGHTS, PREFERENCES
    PRIVILEGES AND RESTRICTIONS OF SHARES

 

MediciNova, Inc.

 

CUSIP [                    ]

 

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

 

THIS CERTIFIES THAT

 

IS THE OWNER OF

 

FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK, $0.001 PAR VALUE PER SHARE, OF

 

MediciNova, Inc.

 

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

 

COUNTERSIGNED AND REGISTERED:

    
    [_________________________________________]    
       

TRANSFER AGENT

AND REGISTRAR

    
   

BY

    
       

AUTHORIZED SIGNATURE

 

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

 

Dated:

 

MediciNova, Inc.

Corporate Seal

 

           

SECRETARY

      

PRESIDENT

 

A statement of 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, as established, from time to time, by the Certificate of Incorporation of the Corporation and by any certificate of determination, the number of shares constituting each class and series, and the designations thereof, may be obtained by the holder hereof upon request and without charge from the Secretary of the Corporation 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    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
          survivorship and not as tenants         Act __________________
          in common              (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 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 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                     

 

                                                                                                             

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.

 

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.