EX-4.5 3 d69158dex45.htm EX-4.5 EX-4.5

EXHIBIT 4.5

 

NUMBER    NUMBER C SHARES
   SEE REVERSE FOR CERTAIN DEFINITIONS
   CUSIP

CLOVER HEALTH INVESTMENTS, CORP.

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

CLASS A COMMON STOCK

This Certifies that                                                                                                                                                                                    

is the owner of                                                                                                                                                                                            

FULLY PAID AND NON-ASSESSABLE SHARES OF CLASS A COMMON STOCK, PAR VALUE OF $0.0001 PER SHARE, OF

CLOVER HEALTH INVESTMENTS, CORP.

(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.

Witness the seal of the Company and the facsimile signatures of its duly authorized officers.

 

Secretary   

[Corporate Seal]

Delaware

   Chief Executive Officer

 

     

 


CLOVER HEALTH INVESTMENTS, CORP.

The Company 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 of the Company 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 all the provisions of the Company’s certificate of incorporation 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
TEN ENT    --    as tenants by the entireties
JT TEN    --   

as joint tenants with right

of survivorship and not

as tenants in common

 

UNIF GIFT MIN ACT --   

 

   Custodian   

 

   (Cust)       (Minor)

 

Under Uniform Gifts to Minors Act  

 

 
(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))

 

 

 

 

 

 

Shares of the capital stock represented by the within Certificate, and does hereby irrevocably constitute and appoint

 

 

Attorney to transfer the said shares on the books of the within named Company with full power of substitution in the premises.

Dated:

 

 

 

 

NOTICE: THE SIGNATURE(S) 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 UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED).