Attached files
file | filename |
---|---|
S-1/A - Aevi Genomic Medicine, Inc. | v212051_s1a.htm |
EX-3.3 - Aevi Genomic Medicine, Inc. | v212051_ex3-3.htm |
EX-4.5 - Aevi Genomic Medicine, Inc. | v212051_ex4-5.htm |
EX-4.4 - Aevi Genomic Medicine, Inc. | v212051_ex4-4.htm |
EX-1.1 - Aevi Genomic Medicine, Inc. | v212051_ex1-1.htm |
EX-23.1 - Aevi Genomic Medicine, Inc. | v212051_ex23-1.htm |
Exhibit 4.1
No.
______
|
Incorporated
under the Laws of the State of Delaware
|
_________
SHARES
|
COMMON
STOCK
SEE
REVERSE FOR CERTAIN DEFINITIONS
THIS CERTIFIES THAT
____________________________________________
IS THE OWNER OF
_______________________________________________
FULLY
PAID AND NON-ASSESSABLE SHARES, PAR VALUE $0.0001 PER SHARE, OF COMMON STOCK
OF
MEDGENICS,
INC.
transferable
on the books of the Corporation by said owner in person or by his duly
authorized attorney upon the surrender of this certificate properly
endorsed. This certificate is not valid until countersigned by the
Transfer Agent and registered by the Registrar.
WITNESS
the facsimile seal of the Corporation and the facsimile signatures of its duly
authorized officers.
Dated:
____________________
MEDGENICS,
INC.
CORPORATE
SEAL
Delaware
|
||
President
|
Secretary
|
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
|
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.
MEDGENICS,
INC.
The
Corporation will furnish without charge to each stockholder who so requests the
powers, designations, preferences and relative, participating, option 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. This certificate and the shares represented hereby are issued
and shall be held subject to the terms and conditions applicable to the
securities underlying and comprising the shares.
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
represented by the within Certificate, and do hereby irrevocably constitute and
appoint _____________________________ Attorney, to transfer the said shares on
the books of the within named Corporation with full power of substitution in the
premises.
Dated
__________________
|
By:
___________________________________________________
|
||
By:
___________________________________________________
|
|||
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.
|
|||
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.
|