Specimen common stock certificate of the Registrant

EX-4.1 4 d562972dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

NUMBER RA INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE    CUSIP 74933X 10 4 SEE REVERSE FOR CERTAIN DEFINITIONS AND LEGENDS    This certifies that    is the record holder of    FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $0.0001 PAR VALUE PER SHARE, OF RA MEDICAL SYSTEMS, INC.    transferable endorsed. This on the Certificate books is of not the valid corporation until countersigned in person or by by the duly Transfer authorized Agent attorney and registered upon surrender by the Registrar. of this Certificate properly WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. Dated:    CHIEF EXECUTIVE OFFICER    CHIEF FINANCIAL OFFICER    R C . JUNE 14 , 2018 RA MEDICAL SYSTEMS, INC. CORPORATE SEAL JUNE 14, 2018 DELAWARE    COUNTERSIGNED AND REGISTERED:AMERICAN STOCK TRANSFER TRUST& COMPANY, LLC (BROOKLYN, NY)                 TRANSFER AGENT AND REGISTRAR BY:AUTHORIZED SIGNATURE

The Corporation shall furnish without charge to each stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock of the Corporation or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights. Such requests shall be made to the Corporation’s Secretary at the principal office of the Corporation.

KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, OR DESTROYED THE CORPORATION WILL REQUIRE A BOND INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT 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
TEN ENT    –     as tenants by the entireties
JT TEN    –     as joint tenants with right of
     survivorship and not as tenants
     in common
COM PROP    –     as community property
                                   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(s), assign(s) 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 capital stock represented by within Certificate, and do hereby irrevocably constitute and appoint                                     

                                                                                                                                                                                                      attorney-in-fact to transfer the said stock on the books of the within named Corporation with full power of the substitution in the premises.

Dated                                                                          

 

     X    

 

 

     X    

 

 

Signature(s) Guaranteed:        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.

 

 

 

By

                                                                                                   

 

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. GUARANTEES BY A NOTARY PUBLIC ARE NOT ACCEPTABLE. SIGNATURE GUARANTEES MUST NOT BE DATED.