EX-4.1 3 a2140251zex-4_1.txt EXHIBIT 4.1 Exhibit 4.1 NUMBER NEUROMETRIX SHARES NM NEUROMETRIX, INC. INCORPORATED UNDER THE LAWS OF SEE REVERSE FOR CERTAIN THE STATE OF DELAWARE DEFINITIONS THIS IS TO CERTIFY THAT CUSIP 641255 10 4 IS THE OWNER OF FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF THE PAR VALUE OF $0.0001 PER SHARE OF ========================== NEUROMETRIX, INC. ========================= TRANSFERABLE UPON THE BOOKS OF THE CORPORATION BY THE HOLDER HEREOF IN PERSON OR BY DULY AUTHORIZED ATTORNEY UPON SURRENDER OF THIS CERTIFICATE PROPERLY ENDORSED. THIS CERTIFICATE IS NOT VALID UNLESS COUNTERSIGNED AND REGISTERED BY THE TRANSFER AGENT AND REGISTRAR. WITNESS THE FACSIMILE SEAL OF THE CORPORATION AND THE FACSIMILE SIGNATURES OF ITS DULY AUTHORIZED OFFICERS. DATED: NEUROMETRIX, INC. CORPORATE /s/ Shai N. Gozani SEAL /s/ Nicholas J. Alessi 2001 PRESIDENT DELAWARE TREASURER COUNTERSIGNED AND REGISTERED: AMERICAN STOCK TRANSFER & TRUST COMPANY (NEW YORK) TRANSFER AGENT AND REGISTRAR BY: AUTHORIZED SIGNATURE
The Corporation will furnish without charge to each stockholder who so requests a statement of the designations, relative rights, preferences, and limitations applicable to each class of shares and the variations in rights, preferences, and limitations determined for each series thereof (and the authority of the Board of Directors to determine variations for future series). Such request may be addressed to the Secretary of the Corporation or to the Transfer Agent and Registrar named on the face of this Certificate. 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 TEN ENT -- as tenants by the entireties ____________ Custodian _____________ (Cust) (Minor) JT TEN -- as joint tenants with right of Under Uniform Gifts to Minors Act survivorship and not as tenants in _______________________ common (State)
Additional abbreviations may also be used though not in the above list. FOR VALUE RECEIVED, ____________________________________ HEREBY SELL, ASSIGN, AND TRANSFER UNDER ------------------------------------------------------------------------------- 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 OWNER 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) 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 17Ad-15.