EX-1 3 staar8a1ex41.txt STOCK CERTIFICATE Exhibit 4.1 ___________ Certificate Number STAAR Shares COMMON STOCK COMMON STOCK INCORPORATED UNDER THE LAWS CUSIP 852321 30 5 OF THE STATE OF DELAWARE STAAR SURGICAL COMPANY SEE REVERSE FOR CERTAIN DEFINITIONS THIS CERTIFIES THAT IS THE OWNER OF FULLY PAID AND NONASSESSABLE SHARES, OF THE PAR VALUE OF ONE CENT($.01) EACH, OF THE COMMON STOCK OF STAAR SURGICAL COMPANY, transferable on 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 until 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: STAAR SURGICAL COMPANY _______________________ ___________________ SEAL PRESIDENT AND SECRETARY CHIEF EXECUTIVE OFFICER Countersigned and Registered: AMERICAN STOCK TRANSFER & TRUST COMPANY (NEW YORK) By Transfer Agent and Registrar Authorized Officer STAAR SURGICAL COMPANY The Corporation will furnish, without charge to each stockholder upon request a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock of the Corporation or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights. 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 _______________ (Cust) (Minor) TEN ENT - as tenants by the entireties under Uniform Gifts to Minors Act ____________________ JT TEN - as joint tenants with right of survivorship (State) and not as tenants in common UNIF TRF MIN ACT - _____________ Custodian (until age _____) (Cust) ________________ under Uniform Transfers (Minor) to Minors Act __________________ (State)
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 Common 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: _____________________ _______________________________________________ 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 MUST BE GUARANTEED BY A COMMERCIAL BANK OR MEMBER FIRM OF ONE OF THE FOLLOWING STOCK EXCHANGES: NEW YORK STOCK EXCHANGE, PACIFIC COAST STOCK EXCHANGE, AMERICAN STOCK EXCHANGE, MIDWEST STOCK EXCHANGE. _______________________________________________