Sucampo Pharmaceuticals, Inc. Class A Common Stock Certificate and Assignment Form

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Summary

This document is a stock certificate issued by Sucampo Pharmaceuticals, Inc. for its Class A Common Stock. It outlines the rights and preferences of the stock, provides instructions for transferring ownership, and includes a form for assignment to a new owner. The certificate requires signatures and a guarantee from an eligible financial institution for any transfer. It also notes that if the certificate is lost or destroyed, the corporation may require a bond before issuing a replacement.

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EX-4.1 2 w20549a5exv4w1.htm EX-4.1 exv4w1  

Exhibit 4.1

 

SUCAMPO PHARMACEUTICALS, INC.
     The Corporation is authorized to issue more than one class of stock. The Corporation will 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 or series thereof of the Corporation, and the qualifications, limitations or restrictions of such preferences and/or rights.
     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
survivorship and not as tenants
in common		           under Uniform Gifts 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
     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.
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 Class A 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                                                                                       
             
 
  X  
 
    
 
            
 
  X  
 
    
Signature(s) Guaranteed:
     
 
    
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.
    
KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, MUTILATED OR DESTROYED, THE CORPORATION MAY REQUIRE A BOND OF INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE.