Form of Merrion Pharmaceuticals plc Ordinary Share Certificate



 Exhibit 4.1 
 

 
 Incorporated under the Companies Acts, 1963 to 2006 – Registered Number 443434 
  

					
		 		 	 Please check that your name and address
 details on the
attached certificate are correct.
 If there is any error in your name, please
 return this certificate to the Company’s
 Registrar, Computershare Investor Services
 (Ireland) Ltd, P.O. Box 954, Heron House,
 Corrig Road. Sandyford Industrial
Estate,
 Dublin 18 with a covering letter.


  

					
		 		 	 To notify the Company’s Registrar of a
 change to
your address please complete the
 change of address form overleaf and then
 detach this counterfoil.


 

 
 Incorporated under the Companies Acts, 1963 to 2006 – Registered Number 443434 
  

			
	CERTIFICATE NO.	  	 NUMBER OF SHARES


 This is to certify that 
 is/are the Registered Holder(s) of 
 fully paid Ordinary Shares of €0.01 each in Merrion Pharmaceuticals plc subject to
the Memorandum and Articles of Association of the Company. 
 GIVEN under the Securities Seal of the Company 
 NO TRANSFER OF ANY THE ABOVE SHARES CAN BE REGISTERED UNLESS ACCOMPANIED BY THIS CERTIFICATE. 
 Transfer Office: Computershare Investor Services (Ireland) Limited, P.O. Box 954, Dublin 18. 
 You can check your shareholding at www.computershare.com 







 Change of Address/Amended Details 
 If your name and address are not shown correctly on the attached share certificate, or if you change your address, please let us know by filling in the form below to show the correct details, sign it and return it to
the Company’s Registrar, Computershare Investor Services (Ireland) Limited, P.O. Box 954, Dublin 18. 
 Please use BLOCK CAPITALS

  

			
	Full Name(s)
                                        
                                  	  	New Address
                                        
                              
	________________________________________________	  	________________________________________________
	Old Address
                                        
                                  	  	________________________________________________
	________________________________________________	  	Postcode
                                        
                                  
		  	(if any)
	________________________________________________	  	Signature(s)
                                        
                             
	Postcode
                                        
                                     	  	Date
                                        
                                        
   
	(if any)	  	

 DETACH THIS FORM BEFORE SENDING IT TO THE REGISTRAR. DO NOT RETURN YOUR SHARE CERTIFICATE WITH
THIS FORM 
  

									
	CREST	  		  	Above this line for Registar’s
Use                            
	TRANSFER	  	Counter Location Stamp	  	Barcode or Reference
		  		  	SDRN
		
		  	  
 Above this line for completion by the depositing
system-user
only                                        
            

		  	Consideration Money €	  	Certificate(s) lodged with Registrar
		  		  		  		  	(to be completed by Registrar)
					
	Name of	  		  		  		  	
	Undertaking	  		  		  		  	
					
	 Description
 of Security
	  		  		  		  	
		  	Amount of shares or other security in words	  		  	Figures
					
	 Please complete
 form in type or in
	  		  		  		  	
	Block Capitals	  		  		  		  	
				
	Name(s) of	  	In the name(s) of	  		  	Designation (if any)
	 registered holder(s)
 should be given in

full: the address
 should be given
 where there is only
 one holder.
	  		  		  		  	  
 Balance Certificate(s) Required

	 If the transfer is not made
 by the
registered
 holder(s) insert also the
 name(s) and
capacity
	  		  		  		  	
	 (e.g. executor(s) of the
 person(s) making

 the transfer).
	  		  		  		  	
		  	I/We hereby transfer the above secutiry out of the name(s) aforesaid into the name(s) of the system-member set out below and request that the necessary entries be made in the
undertaking’s own register of members.	  		  	Stamp of depositing system-user
	 PLEASE SIGN HERE è
	  	Signature(s) of Transferor(s)	  		  	
	  	1. ___________________________________	  		  	
	  	2. ___________________________________	  		  	
	  	3. ___________________________________	  		  	
	  	4. ___________________________________	  		  	
		  	  
 A body corporate should execute this transfer under its common seal
or otherwise in accordance with applicable statutory requirements.
	  		  	Date
		  		  		  	 Participant ID

	 Full name(s) of the
 person(s) to whom

 the security is transferred.
	  		  		  	
		  		  		  	 Member Account ID

	 Such person(s) must
 be a system-
 member.
  
	  		  		  	
	Reference to the Registrar in this form means the registraror registration agent of the undertaking, not the Registrar of Companies at the Companies Registration Office.	  	 CREST Co. Limited is delivering this transfer at the direction and on behalf of the depositing system-user whose stamp appears herin and
does not in any manner or to any extent warrant or represent the validity, genuineness or correctness of the transfer instructions contained herein or the genuineness of the signature(s) of the transferor(s). The depositing system-user by delivering
this transfer to CREST CO. Limited authorises CREST Co. Limited to deliver this transfer for registration and agrees to be deemed for all purposes to be the person(s) actually so delivering this transfer for registration.
  
 This form should be used only for a transfer of a certificated unit of a security to a CREST member
to be held by a CREST member in uncertificated form. It should not be used for conversion of a unit held by a CREST member into uncertificated form.
  
 The CREST rules require that this form be used for the transfer of a unit of a certificated security to a CREST member to be held by that member in uncertificated form.
Any such transfer on this form is exempt from stamp duty.