Form of Common Stock Certificate of Synergetics USA, Inc

Contract Categories: Business Finance - Stock Agreements
EX-4.1 5 c98695exv4w1.htm FORM OF COMMON STOCK CERTIFICATE OF SYNERGETICS USA, INC. exv4w1
 

Exhibit 4.1

 

 

     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.
     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    
                         
 
               (Cust)       (Minor)
TEN ENT   —   as tenants by the entireties                
 
                            
JT TEN   —   as Joint tenants with right of       under Uniform Gifts to Minors    
 
      survivorship and not as tenants in common       Act            
                         
                    (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 ZIP CODE, OF ASSIGNEE)
 
 
 
 
 
 
shares of the capital 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
       
 
       
         
 
       
 
  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 WHATEVER.
Signature(s) 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. RULE 17Ad-15.    
 
KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, MUTILATED OR DESTROYED, THE CORPORATION WILL REQUIRE A BOND OF INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE.