Oculus Innovative Sciences, Inc. Common Stock Certificate and Assignment Form

Summary

This document is a stock certificate issued by Oculus Innovative Sciences, Inc. It certifies ownership of shares of the company's common stock and includes an assignment form for transferring shares to another party. The certificate outlines the rights and preferences of the stock, and provides instructions for requesting further information. To transfer shares, the owner must complete the assignment section, provide identifying information for the assignee, and obtain a signature guarantee from an eligible financial institution.

EX-4.1 5 f21666a4exv4w1.htm EXHIBIT 4.1 exv4w1

Exhibit 4.1

Stock Certificate CUSIP 675759 10 8

OCULUS INNOVATIVE SCIENCES, INC.

The Corporation will furnish without charge to each stockholder who so requests 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. Such request shall be made to the Corporation’s Secretary 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


TEN ENT —		as tenants by the entireties


JT TEN —		as joint tenants with right of survivorship and not as tenants in common


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, assign 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 Common Stock represented by the within Certificate, and do(es) 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		X


		X

		NOTICE:	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.
SIGNATURES	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. RULE17Ad-15.