Form of Specimen Ordinary Shares Certificate of Roadzen Inc

EX-4.1 3 d537808dex41.htm EX-4.1 EX-4.1

Exhibit 4.1

 

NUMBER    SHARES
C-   

SEE REVERSE FOR CERTAIN DEFINITIONS

CUSIP G7606H 108

ROADZEN INC.

ORDINARY SHARES

THIS CERTIFIES THAT     is the owner of    ordinary shares, par value $0.0001 per share (each, an “Ordinary Share”), of Roadzen Inc., a British Virgin Islands business company (the “Company”), transferable on the books of the Company in person or by duly authorized attorney upon surrender of this certificate properly endorsed.

This certificate is not valid unless countersigned by the Transfer Agent and registered by the Registrar of the Company.

Witness the facsimile signature of a duly authorized signatory of the Company.

 

Authorized Signatory           Transfer Agent

 

    

 

Roadzen Inc.

The Company will furnish without charge to each shareholder who so requests, a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of equity or series thereof of the Company and the qualifications, limitations, or restrictions of such preferences and/or rights. This certificate and the shares represented thereby are issued and shall be held subject to all the provisions of the Amended and Restated Memorandum and Articles of Association of the Company and all amendments thereto and resolutions of the Board of Directors providing for the issue of securities (copies of which may be obtained from the secretary of the Company), to all of which the holder of this certificate by acceptance hereof assents.

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        
            

Under Uniform Gifts to Minors Act

               

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

Additional abbreviations may also be used though not in the above list.

For value received,    hereby sells, assigns and transfers unto

(PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER(S) OF ASSIGNEE(S))

(PLEASE PRINT OR TYPEWRITE NAME(S) AND ADDRESS(ES), INCLUDING ZIP CODE, OF ASSIGNEE(S))

Ordinary Shares represented by the within certificate, and do hereby irrevocably constitute and appoint

Attorney to transfer the said Ordinary Shares on the books of the within named Company 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:  

 

    
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 UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED (OR ANY SUCCESSOR RULE)).