MaxQ AI Ltd. - FORM S-1 - EX-4.1 - FORM OF CERTIFICATE FOR ORDINARY SHARES - August 9, 2018

Attached files

file filename
EX-10.10.1 - FORM OF LOCKUP AGREEMENT (12 MONTHS) FOR OFFICERS, DIRECTORS AND SHAREHOLDERS OF - MaxQ AI Ltd.fs12018ex10-10i_maxqai.htm
EX-3.1 - ARTICLES OF ASSOCIATION - MaxQ AI Ltd.fs12018ex3-1_maxqai.htm
S-1 - REGISTRATION STATEMENT - MaxQ AI Ltd.fs12018_maxqailtd.htm
EX-99.2 - CONSENT OF SCOTT A. SNYDER, NOMINEE FOR DIRECTOR - MaxQ AI Ltd.fs12018ex99-2_maxqai.htm
EX-99.1 - CONSENT OF SAMANTHA ALLISON, NOMINEE FOR DIRECTOR - MaxQ AI Ltd.fs12018ex99-1_maxqai.htm
EX-23.1 - CONSENT OF KOST FORER GABBAY & KASIERER, A MEMBER OF ERNST & YOUNG GLOBAL, AN IN - MaxQ AI Ltd.fs12018ex23-1_maxqai.htm
EX-10.22 - ENGLISH SUMMARY OF PRINCIPLE TERMS OF LEASE AGREEMENT, EFFECTIVE MAY 15, 2018, B - MaxQ AI Ltd.fs12018ex10-22_maxqai.htm
EX-10.21 - ENGLISH SUMMARY OF PRINCIPLE TERMS OF LEASE AGREEMENT, DATED MAY 16, 2015, BY AN - MaxQ AI Ltd.fs12018ex10-21_maxqai.htm
EX-10.20 - AMENDED AND RESTATED EMPLOYMENT AGREEMENT, EFFECTIVE AS OF THE CLOSING OF THE IN - MaxQ AI Ltd.fs12018ex10-20_maxqai.htm
EX-10.18 - CONSULTING AGREEMENT, DATED DECEMBER 1, 2014, BETWEEN MEDYMATCH TECHNOLOGY LTD. - MaxQ AI Ltd.fs12018ex10-18_maxqai.htm
EX-10.11 - PLACEMENT AGENT & ADVISORY AGREEMENT BETWEEN PALLADIUM CAPITAL ADVISORS, LLC AND - MaxQ AI Ltd.fs12018ex10-11_maxqai.htm
EX-10.10.3 - FORM OF LOCKUP AGREEMENT (SIX MONTHS, PLUS FOUR-MONTH "LEAK-OUT") FOR EACH PURCH - MaxQ AI Ltd.fs12018ex10-10iii_maxqai.htm
EX-10.10.2 - FORM OF LOCKUP AGREEMENT (10 MONTHS, PLUS TWO-MONTH "LEAK-OUT") FOR EXIGENT TOTA - MaxQ AI Ltd.fs12018ex10-10ii_maxqai.htm
EX-10.9 - OMNIBUS AMENDMENT AGREEMENT NUMBER THREE, DATED AUGUST 7, 2018, BY AND BETWEEN M - MaxQ AI Ltd.fs12018ex10-9_maxqailtd.htm
EX-10.8 - OMNIBUS AMENDMENT AGREEMENT NUMBER TWO, DATED AUGUST 1, 2018 - MaxQ AI Ltd.fs12018ex10-8_maxqai.htm
EX-10.7 - OMNIBUS AMENDMENT AGREEMENT, DATED MARCH 23, 2018 - MaxQ AI Ltd.fs12018ex10-7_maxqai.htm
EX-10.6 - REGISTRATION RIGHTS AGREEMENT, DATED DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-6_maxqai.htm
EX-10.5.2 - AMENDMENT NO. 1 TO REGISTRATION RIGHTS AGREEMENT, DATED MARCH 23, 2018 - MaxQ AI Ltd.fs12018ex10-5ii_maxqai.htm
EX-10.5.1 - REGISTRATION RIGHTS AGREEMENT, DATED DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-5i_maxqai.htm
EX-10.4.4 - SECURITY AGREEMENT (FLOATING CHARGE) DATED DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-4iv_maxqai.htm
EX-10.4.3 - SECURITY AGREEMENT (FIXED CHARGE) DATED DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-4iii_maxqai.htm
EX-10.4.2 - FORM OF SECURED CONVERTIBLE NOTE ISSUED ON DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-4ii_maxqai.htm
EX-10.4.1 - SECURITIES PURCHASE AGREEMENT, DATED AS OF DECEMBER 29, 2017 - MaxQ AI Ltd.fs12018ex10-4i_maxqai.htm
EX-10.3 - FORM OF INDEMNIFICATION AGREEMENT - MaxQ AI Ltd.fs12018ex10-3_maxqai.htm
EX-10.2 - FORM OF GRANT LETTER AND SHARE OPTION AGREEMENT - MaxQ AI Ltd.fs12018ex10-2_maxqai.htm
EX-10.1 - MAXQ AI LTD. 2015 SHARE INCENTIVE PLAN - MaxQ AI Ltd.fs12018ex10-1_maxqai.htm

Exhibit 4.1

 

Number:

Shares

   
MQAI

CUSIP

 

See Reverse for
Certain Definitions

  

MAXQ AI LTD.
INCORPORATED UNDER THE LAWS OF THE STATE OF ISRAEL

 

THIS CERTIFIES that    
     
     
is the Registered Holder of    

 

FULLY PAID AND NON-ASSESSABLE ORDINARY
SHARES OF NIS 0.01 PAR VALUE EACH

 

of MaxQ AI LTD. transferable on the books of the Company by the holder hereof in person or by duly authorized attorney only upon surrender of this Certificate properly endorsed or with an appropriate instrument of transfer. This Certificate and the shares represented hereby are issued and shall be held subject to all the provisions of the Articles of Association of the Company and amendments thereto, to all of which the holder by the acceptance hereof assents. This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar.

 

IN WITNESS WHEREOF, the Company has caused this Certificate to be issued under the facsimile seal of the Company.

 

Dated:    

 

MaxQ AI Ltd. Corporate Seal ISRAEL
   
Chairman and Chief Executive Officer Director

  

 

 

 

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 Under Uniform Gifts to Minors Act
TEN ENT - as tenants by the entireties Custodian (Cust) (Minor)
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 OF ASSIGNEE    
     
PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE    
     
                                           SHARES REPRESENTED BY THE WITHIN CERTIFICATE, AND SO HEREBY IRREVOCABLY CONSTITUTES AND APPOINTS ATTORNEY TO TRANSFER THE SAID SHARES ON THE BOOKS OF THE WITHIN-NAMED CORPORATION AND 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, WHATSOEVER.
     
Signature(s) Guaranteed:    
     
     
     
THE SIGNATURE(S) SHOULD 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 17 Ad-15