SEMLER SCIENTIFIC, INC. CORPORATE STOCK TRANSFER, INC. TRANSFER FEE: AS REQUIRED

EX-4.1 2 t1300651_ex4-1.htm EXHIBIT 4.1

Exhibit 4.1

This Certifies That

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

AUTHORIZED: 50,000,000 COMMON SHARES,

$0.001 PAR VALUE PER SHARE

CUSIP 81684M 10 4

SEE REVERSE FOR

CERTAIN DEFINITIONS

is the owner of

Fully Paid and Non-Assessable Common Stock, $0.001 Par Value of

SEMLER SCIENTIFIC, INC.

transferable on the books of this Corporation in person or by attorney upon surrender of this Certificate duly endorsed or assigned. This Certificate and the shares represented hereby are subject to the laws of the State of Delaware, and to the Certificate of Incorporation and the Bylaws of the Corporation, as now or hereafter amended. This Certificate is not valid until countersigned by the Transfer Agent.

IN WITNESS WHEREOF, the Corporation has caused this Certificate to be signed by the facsimile signatures of its duly authorized officers and to be sealed with the facsimile seal of the Corporation.

Countersigned:

CORPORATE STOCK TRANSFER, INC.

3200 Cherry Creek South Drive, Suite 430

Denver, CO 80209

Transfer Agent and Registrar Authorized Officer

Dated:

001 CHIEF EXECUTIVE OFFICER / SECRETARY VICE PRESIDENT OF FINANCE / ASSISTANT SECRETARY

SEMLER SCIENTIFIC, INC.

CORPORATE STOCK TRANSFER, INC.

TRANSFER FEE: AS REQUIRED

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	UNIF GIFT MIN ACT -	Custodian
JT TEN -	as joint tenants with right		(Cust)	(Minor)
	of survivorship and not as		under Uniform Gifts to Minors
	tenants in common

	Act
		(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

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

Dated: 20 ,

	Signature: X
Signature(s) Guaranteed:
	Signature: X

THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER. 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.