Specimen Common Stock Certificate of the Registrant



  
 Exhibit 4.1


 

 

  
 016570|
003590|127C|RESTRICTED||4|057-423 
 COMMON STOCK 

PAR VALUE $0.001 
 COMMON STOCK 
 THIS CERTIFICATE IS TRANSFERABLE IN
CANTON, MA AND NEW YORK, NY 
 ZALICUS 
 Certificate Number 
 ZQ 000000 

Shares 
 * * 6 0 0 6 2 0 * * * * * * 
 * * * 6 0 0 6 2 0 * *
* * * 
 * * * * 6 0 0 6 2 0 * * * * 
 * * * * * 6 0 0 6 2 0 * * * 
 * * * * * * 6 0 0 6 2
0 * * 
 ZALICUS INC. 
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 
 THIS CERTIFIES THAT 
 MR. SAMPLE & MRS. SAMPLE
& MR. SAMPLE & MRS. SAMPLE 
 ** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr.
Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample
**** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David
Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander
David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr.
Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample
**** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David
Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Sample **** Mr. Sample 
 CUSIP 98887C 10 5 
 SEE REVERSE FOR CERTAIN
DEFINITIONS 
 is the owner of 
 * * * SIX HUNDRED THOUSAND SIX HUNDRED AND TWENTY* * * 
 **600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares***
*600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****
600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****6
00620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****60
0620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600
620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares***600620**Shares****600620**Shares****60062
0**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620
**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620*
*Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**
Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**S
hares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Shares****600620**Sh 
 FULLY PAID AND NON-ASSESSABLE SHARES, OF COMMON STOCK, OF $0.001 PAR VALUE, 
 Zalicus Inc. transferable only 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 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. 
 President and
Chief Executive Officer 
 Treasurer 
 DATED <<Month Day, Year>> 

COUNTERSIGNED AND REGISTERED: 
 COMPUTERSHARE TRUST COMPANY, N.A. 
 TRANSFER AGENT
AND REGISTRAR, 
 By 
 AUTHORIZED SIGNATURE 
 ZALICUS INC. 

2000 
 DELAWARE 
 ZALICUS 

PO BOX 43004, Providence, RI 02940-3004 
 MR A SAMPLE DESIGNATION (IF ANY) 
 ADD 1

 ADD 2 
 ADD 3 
 ADD 4 

CUSIP XXXXXX XX X 
 Holder ID XXXXXXXXXX 
 Insurance Value 1,000,000.00

 Number of Shares 123456 
 DTC 12345678 123456789012345 
 Certificate Numbers
Num/No. Denom. Total 
 1234567890/1234567890 1 1 1 

1234567890/1234567890 2 2 2 
 1234567890/1234567890 3 3 3 
 1234567890/1234567890
4 4 4 
 1234567890/1234567890 5 5 5 
 1234567890/1234567890 6 6 6 
 Total Transaction 7


			
	 	  	 








  

 

 

  
 ZALICUS INC.

 The Corporation will furnish without charge to each stockholder who so requests a statement of 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. 

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 

(State) 
 JT TEN - as joint tenants with right of survivorship UNIF TRF MIN ACT - Custodian (until age) 
 (Cust) 
 under Uniform Transfers to Minors Act

 (Minor) (State) 
 Additional abbreviations may also be used though not in the above list. 
 PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE 
 For value received, hereby sell, assign and transfer unto 
 (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL 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 power of substitution in the premises.

 Dated: 20 
 Signature(s) Guaranteed: Medallion Guarantee Stamp 

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. 
 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. 
 SECURITY INSTRUCTIONS 

THIS IS WATERMARKED PAPER. DO NOT ACCEPT WITHOUT NOTING WATERMARK. HOLD TO LIGHT TO VERIFY WATERMARK. 

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