EX-4.1 2 d594375dex41.htm FORM OF COMMON STOCK CERTIFICATE Form of Common Stock certificate

Exhibit 4.1

LOGO

 

ABnote North America

711 ARMSTRONG LANE

COLUMBIA, TENNESSEE 38401

(931) 388-3003

SALES: HOLLY GRONER 931-490-7660

PROOF OF: OCTOBER 22, 2013

HCI GROUP, INC.

WO- 7690 FACE

OPERATOR: DKS

New

Colors Selected for Printing: Intaglio prints in SC-7 Dark Blue.

PLEASE INITIAL THE APPROPRIATE SELECTION FOR THIS PROOF: OK AS IS OK WITH CHANGES MAKE CHANGES AND SEND ANOTHER PROOF

COLOR: This proof was printed from a digital file or artwork on a graphics quality, color laser printer. It is a good representation of the color as it will appear on the final product.

However, it is not an exact color rendition, and the final printed product may appear slightly different from the proof due to the difference between the dyes and printing ink.

FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK, NO PAR VALUE PER SHARE, OF

HCI Group, Inc.

transferable on the books of the Corporation 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 facsimile signatures of the Corporation’s duly authorized officers.

Dated:

CUSIP 40416E 10 3

SEE REVERSE FOR CERTAIN DEFINITIONS

THIS CERTIFIES THAT

is the owner of

HCI Group, Inc.

INCORPORATED UNDER THE LAWS OF THE STATE OF FLORIDA

COMMON STOCK COMMON STOCK

S H A R E S

HC

COUNTERSIGNED AND REGISTERED:

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC

(Brooklyn, NY)

TRANSFER AGENT AND REGISTRAR

BY

AUTHORIZED SIGNATURE

ANDREW L. GRAHAM

SECRETARY

PARESH PATEL

PRESIDENT


LOGO

 

ABnote North America

711 ARMSTRONG LANE

COLUMBIA, TENNESSEE 38401

(931) 388-3003

HOLLY GRONER 931-490-7660

PROOF OF: OCTOBER 22, 2013

HCI GROUP, INC.

WO- 7690 BACK

OPERATOR: DKS

NEW

PLEASE INITIAL THE APPROPRIATE SELECTION FOR THIS PROOF: OK AS IS OK WITH CHANGES MAKE CHANGES AND SEND ANOTHER PROOF

For value received, hereby sell, assign and transfer unto

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

TEN ENT

JT TEN

– as tenants in common

– as tenants by the entireties

– 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)

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.

PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE

Shares

of the common stock represented by the within Certificate, and do hereby irrevocably

constitute and appoint

PLEASE INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE

Attorney to transfer the said stock on the books of the within-named Corporation with full power of

substitution in the premises.

This certificate also evidences and entitles the holder hereof to certain rights as set forth in the Rights Agreement between HCI Group, Inc.

and American Stock Transfer & Trust Company, LLC, dated as of October 18, 2013, as it may be amended from time to time (the

“Agreement”), the terms of which are hereby incorporated herein by reference and a copy of which is on file at the principal executive offices

of HCI Group, Inc. Under certain circumstances, as set forth in the Agreement, such Rights (as defined in the Agreement) will be evidenced

by separate certificates and will no longer be evidenced by this certificate. HCI Group, Inc. will mail to the holder of this certificate a copy of

the Agreement without charge after receipt of a written request therefor. As set forth in the Agreement, Rights Beneficially Owned by any

Person (as defined in the Agreement) who becomes an Acquiring Person (as defined in the Agreement) become null and void.

Dated,

SIGNATURE(S) GUARANTEED:

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.

Additional abbreviations may also be used though not in the above list.

NOTICE:

The Corporation will furnish without charge to each shareholder who so requests the powers, designations, preferences

and relative, participating, optional, or other special rights of each class of stock or series thereof and the qualifications, limitations

or restrictions of such preferences and/or rights. Such requests shall be made to the Corporation’s Secretary at the principal office

of the Corporation.

NOTE: TEXT RECEIVED BY MODEM OR E-MAIL IS NOT PROOFREAD WORD FOR WORD.