Form of Registrant's Common Stock Certificate



 Exhibit 4.1 

 

 

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

Certificate Number 

ZQ 000000 

PROMETHEUS RxDxTM 

PROMETHEUS RXDX, INC. 

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 

COMMON STOCK 

THIS CERTIFICATE IS TRANSFERABLE IN CANTON, MA AND NEW YORK, NY 

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 * * 

THIS CERTIFIES THAT 

MR. SAMPLE & MRS. SAMPLE & 

MR. SAMPLE & MRS. SAMPLE 

CUSIP 74344H 10 2 

SEE REVERSE FOR CERTAIN DEFINITIONS 

is the owner of 

* * * SIX HUNDRED THOUSAND 

SIX HUNDRED AND TWENTY* * * 

FULLY-PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF 

Prometheus RxDx, Inc. (hereinafter called the “Company”), transferable on the books of the Company in person or
by duly authorized attorney, upon surrender of this Certificate properly endorsed. This Certificate and the shares represented hereby, are issued and shall be held subject to all of the provisions of the Certificate of Incorporation, as amended, and
the By-Laws, 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 Certificate is not valid unless countersigned and registered by the
Transfer Agent and Registrar. 
 Witness the facsimile seal of the Company and the facsimile signatures of its
duly authorized officers. 
 President, Chief Executive Officer 

Secretary 

Prometheus RxDx, Inc. 

SEAL 

2009 

Delaware 

DATED <<Month Day, Year>> 

COUNTERSIGNED AND REGISTERED: 

COMPUTERSHARE TRUST COMPANY, N.A. 

TRANSFER AGENT AND REGISTRAR, 

By 

AUTHORIZED SIGNATURE 

Printed by DATA BUSINESS FORMS 

SECURITY INSTRUCTIONS ON REVERSE 

1234567 

PROMETHEUS RxDxTM 

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 








	
	 

 PROMETHEUS RXDX, INC. 

 
 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 FIXED BY THE CERTIFICATE OF INCORPORATION OF THE COMPANY, AS AMENDED, 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 SUCH CERTIFICATE. 

 

									
	  

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 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 Company 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 signatures 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.