Attached files

file filename
EX-23.1 - CONSENT OF FRIEDMAN, LLP - DERMAdoctor, Inc.fs12018a1ex23-1_derma.htm
EX-21.1 - SUBSIDIARIES OF DERMADOCTOR, INC. - DERMAdoctor, Inc.fs12018a1ex21-1_derma.htm
EX-10.12 - FORM OF SALE PROCEEDS SHARING AGREEMENT - DERMAdoctor, Inc.fs12018a1ex10-12_derma.htm
EX-4.2 - FORM OF REPRESENTATIVE'S WARRANT - DERMAdoctor, Inc.fs12018a1ex4-2_derma.htm
EX-1.1 - FORM OF UNDERWRITING AGREEMENT - DERMAdoctor, Inc.fs12018a1ex1-1_derma.htm
S-1/A - AMENDMENT NO.1 TO FORM S-1 - DERMAdoctor, Inc.fs12018a1_dermadoctor.htm

Exhibit 4.1

 

 

 

 

 

 

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 the right of Act .........................      
     survivorship and not as tenants (State)           
     in common      

 

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    

 

X  

THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THIS CERTIFICATE. THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions).

 

 

 

 

SIGNATURE GUARANTEED:

 

 

 

TRANSFER FEE WILL APPLY