Form of Class A common stock Certificate



 Exhibit 4.1 

 

	
	




	 NUMBER
 HII
 Health Insurance Innovations

SHARES
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

CUSIP
 SEE REVERSE FOR CERTAIN DEFINITIONS
 This Certifies
that
 is the owner of
 FULLY PAID AND NONASSESSABLE SHARES OF CLASS A COMMON STOCK, $0.001 PAR VALUE PER SHARE, OF HEALTH INSURANCE INNOVATIONS, INC. 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 and the shares represented hereby are subject to the laws of the State of Delaware, and to the Certificate of Incorporation and
Bylaws of the Corporation, as now in effect or as hereafter amended. 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.
 CERTIFICATE OF STOCK
 Dated:

TREASURER
 Health Insurance Innovations, Inc.

CORPORATE
 SEAL
 2012

DELAWARE
 PRESIDENT
 © SECURITY-COLUMBIAN UNITED STATES
BANKNOTE COMPANY 1960
 COUNTERSIGNED AND REGISTERED:

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC
 (Brooklyn, N.Y.)
 TRANSFER AGENT AND
REGISTRAR
 BY
 AUTHORIZED SIGNATURE
 ABnote North
America
 711 ARMSTRONG LANE
 COLUMBIA, TENNESSEE 38401
 (931)
388-3003
 HOLLY GRONER 931-490-7660
 PROOF OF: JANUARY 14, 2013
 HEALTH INSURANCE
INNOVATIONS
 WO- 6416 FACE
 OPERATOR: MR REV.1
 Colors Selected for Printing:
Intaglio prints in PMS 2767. logo prints in PMS 202 Red and PMS 2767 Blue
 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.

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

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









 THE CORPORATION WILL FURNISH TO ANY STOCKHOLDER, UPON REQUEST AND WITHOUT CHARGE, A FULL
STATEMENT OF THE DESIGNATIONS, RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF THE SHARES OF EACH CLASS AND SERIES AUTHORIZED TO BE ISSUED, SO FAR AS THE SAME HAVE BEEN DETERMINED, AND OF THE AUTHORITY, IF ANY, OF THE BOARD TO DIVIDE THE SHARES INTO
CLASSES OR SERIES AND TO DETERMINE AND CHANGE THE RELATIVE RIGHTS, PREFERENCES AND LIMITATIONS OF ANY CLASS OR SERIES. 
 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	 	  

	TEN ENT	 	—	 	  as tenants by the entireties	 		 	(Cust)	 		 	(Minor)
	JT TEN	 	—	 	  as joint tenants with right	 		 	under Uniform Gifts to Minors


											
		 		 	of survivorship and not as	 		 	Act	 	  

		 		 	tenants in common	 		 		 	(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 TYPE NAME AND ADDRESS INCLUDING ZIP CODE OF ASSIGNEE 

 
  
  

 
  

			
	  
	 	Shares

  

			
	of the 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(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE
WHATSOEVER.

  

			
	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.