EX-4.1 2 d47806exv4w1.htm SPECIMEN STOCK CERTIFICATE exv4w1
 

(CERTIFICATE)
999999| 999999|2729C(RESTRICTED123456789Q1234jDTC 99999 *TEST * TEST DMA| 3(9999-99999 Number . ipcx/A MTA r*P f"\DDf*lD ATIOKI **999999****” \XxYll            v\xVy\ ‘IMOC WWIxrUrvMI IwlN iT/XA/ ***999999***-* I            r KQQRPORATED UNDER THE LAWS OF THE STATE OF COLORAC?6 ***999999*** J£<S :V**»V -TS« . ‘” . BUfr r T’TESTOXXJtf- T’resrWXW            FHBKTCu9 V n!U — T’Tu*O”~f* O*t*I I CO TLJ fCT’ :OC™’™-l5’ATE5rQFA’CEKn*t TE’I GUP”‘X>JKXXTII5TJTE ‘TE5rX .. -___. ‘_’’_’’.. ‘ ’ ‘ . — .. ‘ —— —— -— —— — nffsKC[3’ t-ii 1J* j#eu#&i “-- rr-l-iw i>JET\’|l’ 11 ito. 1-I7|A\J “ ouT +raoatJt rf ffiX A/jjy’TtJf lt c%JC iJBp ‘< nn Tpig rTTi“Jiuff aLy’iXytyT xxjm’yEsf ___IKf gE’. 1 .fj gHt K JSjfkxak- Eyj Sgj TEs-’juof ‘ V/VjAq fyic a - -Liooi-1&ifc IkrkJxJj t” j-L> gfci/\JATArjA ‘cHr nCM£ CUS X P 532 2“2 K -~-I“Q”~~ -"~” “ ST’)OOOWESTT6T*XXJC<XT I3A ESTDf“A’C£fflF[CATeWttiUT “XXX5»(*TtS            WBfflffi            Sfti’fe
FULLY-PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF
Lifevantage Corporation (hereinafter called the “Company”), transferable on the books of the Company in person or by duly authorized attorney, upon surrender of this Certificate property endorsed. This Certificate and
the shares represented hereby, are issued and shall be held subject to all of the provisions of the Articles of lii Mlill!
Incorporation, as amended, and the Bylaws, as amended, of the Company (copies of which are on file with the
Company and with the Transfer Agent), to all of which each holder, by acceptance .hereof, assents. This Certifi( 4s-nQt aJiri t            and registered by the Transfer Apent’aTid RegjE Far ,
Witness the faosmlite seal of the Company and the facsimile signatures of its duly authorized officers.


 

(FORM)
LIFEVANTAGE CORPORATION TRANSFER FEE $25.00 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 commonUNIF GIFT MIN ACT-Custodian ... . (Cust)(Minor) TEN ENT — as tenants by the entiretiesunder Uniform Gifts to Minors Act (State) JTTEN -as joint tenants with right of survivorship            UNIF TRF MIN ACT Custodian (until age.. .} and not as tenants in common(Gust)(Minor) under Uniform Transfers to Minors Act (Slate) Additional abbreviations may also be used though not in the above list THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS. PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND RIGHTS. AND THE VARIATIONS IN RIGHTS, PREFERENCES AND LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIX ED BY THE ARTICLES OF INCORPORATION OF THE COMPANY, AS AM ENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR FUTURE SERIES. SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT. THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY S UCH CERTIFICATE, PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE For value received,hereby sell, assign and transfer unto (PLEASE PRWTORIYPEWRrTE NAME AND ADDRESS. INCLUDING POSTAL TIP 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. Oated’20Signature(s) Gmranteed: Meda 11 io ri Guarantee Sta mp ‘"""' ‘ THE SIGNATURE^) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Slockbratos. Savings and Loan Association and Credit Unions) WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE M EDAWON PROGRAM, PURSUANT TO S.E.C. RULE 17M-m Signature: Signature: 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. "^ id] FEE1 /r^ R Fi\ n FF3 r\ n O) r £ llri M P N\ ^ U . Lbn V^7 jj |J\V|J |5 |J\j SECURITY INSTRUCTIONSc’rvdL