Stock Certificate Assignment and Transfer Form
This document is a standard form used to transfer ownership of common stock from one party to another. The current holder of the stock certificate authorizes the sale, assignment, and transfer of shares to a new owner, whose identifying information must be provided. The form also appoints an attorney to process the transfer on the corporation's records. Signatures must match the names on the certificate exactly and be guaranteed by an eligible financial institution, as required by SEC regulations.
Exhibit 4.1
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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 |
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TEN ENT | - | as tenants by the entireties | (Cust) | (Minor) | ||||||||
JT TEN | - | as joint tenants with right of survivorship and not as tenants in common | under Uniform Gifts to Minors | |||||||||
Act |
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(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 POSTAL ZIP CODE OF ASSIGNEE)
| Shares of |
the Common Stock represented by the within Certificate, and do hereby irrevocably constitute and appoint |
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| Attorney |
to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises.
Dated: |
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x |
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x |
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NOTICE: | THE SIGNATURE(S)TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THIS CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER. |
Signature(s) Guaranteed | ||
BY: |
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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. |