Document:

Specimen Unit Certificate

 EXHIBIT 4.1 
  

			
	 NUMBER
 U-                    
	  	UNITS

 SEE REVERSE FOR 
 CERTAIN DEFINITIONS 
 GOLDEN POND HEALTHCARE, INC. 
 CUSIP 
 UNITS CONSISTING OF ONE SHARE OF COMMON STOCK AND 
 ONE WARRANT TO PURCHASE ONE SHARE OF COMMON STOCK 
 THIS CERTIFIES THAT
                                        
                                        
                                        
                                 is the owner of
                                        
                         Units. 
 Each Unit (“Unit”) consists of one (1) share of common stock, par value $0.001 per share (“Common Stock”), of Golden Pond Healthcare, Inc., a Delaware corporation (the
“Corporation”), and one warrant (the “Warrant”). The Warrant entitles the holder to purchase one (1) share of Common Stock for $6.00 per share (subject to adjustment). The Warrant will become exercisable on the later of
(i) the Corporation’s completion of an acquisition of one or more domestic or international operating businesses through a merger, capital stock exchange, asset or stock acquisition or other similar business combination and
(ii)                      [one year after the effective date of the registration statement relating to the initial public offering of the
Units], and will expire unless exercised before 5:00 p.m., New York City time, on                     , 2011 [four years after the effective
date of the registration statement relating to the initial public offering of the Units], or earlier upon redemption (the “Expiration Date”). The Common Stock and Warrants comprising the Units represented by this certificate are not
transferable separately prior to five business days following the earlier to occur of (1) the expiration or termination of the underwriters’ over-allotment option in connection with the Corporation’s initial public offering or
(2) the exercise in full of such underwriters’ over-allotment option, subject in either case to the Corporation filing a Current Report on Form 8-K with the Securities and Exchange Commission containing an audited balance sheet reflecting
the Corporation’s receipt of the gross proceeds of its initial public offering and issuing a press release announcing when such separate trading will begin. The terms of the Warrant are governed by a Warrant Agreement, dated as of
                    , 2007, between the Corporation and Continental Stock Transfer & Trust Company, as Warrant Agent, and are subject
to the terms and provisions contained therein, all of which terms and provisions the holder of this certificate consents to by acceptance hereof. Copies of the Warrant Agreement are on file at the office of the Warrant Agent at 17 Battery Place, New
York, New York 10004, and are available to any Warrant holder on written request and without cost. 
 This certificate is not valid unless
countersigned by the Transfer Agent and Registrar of the Corporation. 
 Witness the facsimile seal of the Corporation and the facsimile
signature of its duly authorized officers. 
  

 1 

 GOLDEN POND HEALTHCARE, INC. 
 CORPORATE 
 DELAWARE 
 SEAL 
 2007 
  

					
	 By:
	 	  
	 	  

		 	Chairman of the Board	 	Secretary
			
	 By:
	 	  
	 	
		 	Transfer Agent	 	

 GOLDEN POND HEALTHCARE, 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 of the Corporation 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             
	 TEN ENT
	 	 —      as tenants by the entireties
	  		  		  	(Cust)                      (Minor)
	 JT TEN
	 	 —      as joint tenants with
 right of survivorship and
 not as
tenants in common
	  		  		  	 under Uniform Gifts to
 Minors Act                         
                             (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 TYPEWRITE NAME AND ADDRESS,
 INCLUDING ZIP CODE, OF ASSIGNEE)

	  
  

	
	  
  

	                                      
                                        
                                        
                               UNITS REPRESENTED BY THE WITHIN CERTIFICATE, AND DO HEREBY
IRREVOCABLY CONSTITUTE AND APPOINT                      ATTORNEY TO TRANSFER THE SAID UNITS ON THE BOOKS OF THE WITHIN NAMED CORPORATION WITH
FULL POWER OF SUBSTITUTION IN THE PREMISES.

  

									
		 		 		 		 	  

	 DATED:
	 		 	  
	 		 	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.

  

 3 

	
	 Signature(s) Guaranteed:

	  
  

	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).Specimen Common Stock Certificate

 EXHIBIT 4.2 
  

			
	NUMBER	  	SHARES                     

 GOLDEN POND HEALTHCARE, INC. 
 INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 
 COMMON STOCK 
 SEE REVERSE FOR 
 CERTAIN DEFINITIONS 

THIS CERTIFIES THAT 
 CUSIP 
 IS THE OWNER OF 
 FULLY PAID AND NON-ASSESSABLE SHARES OF THE PAR VALUE OF
$0.001 EACH OF THE COMMON STOCK OF 
 GOLDEN POND HEALTHCARE, INC. 
 TRANSFERABLE ON THE BOOKS OF THE CORPORATION IN PERSON OR BY DULY AUTHORIZED ATTORNEY UPON SURRENDER OF THIS CERTIFICATE PROPERLY ENDORSED. THIS CERTIFICATE IS NOT VALID UNLESS COUNTERSIGNED BY THE TRANSFER AGENT AND
REGISTERED BY THE REGISTRAR. WITNESS THE SEAL OF THE CORPORATION AND THE FACSIMILE SIGNATURES OF ITS DULY AUTHORIZED OFFICERS. 
 DATED: 
 GOLDEN POND HEALTHCARE, INC. 
 CORPORATE

 DELAWARE 
 SEAL 
 2007 
  

					
	 By:
	 	  
	 	  

		 	Chairman of the Board	 	Secretary
			
	 By:
	 	  
	 	
		 	Transfer Agent	 	

  

 1 

 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 of survivorship and
 not as
tenants in common
	  		  	 under Uniform Gifts to
 Minors Act
                        
                             (State)

 Additional Abbreviations may also be used though not in the above list. 
 GOLDEN POND HEALTHCARE, INC. 
 The Company
will furnish without charge to each stockholder who so requests the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock or series thereof of the Corporation and the qualifications,
limitations, or restrictions of such preferences and/or rights. This certificate and the shares represented thereby are issued and shall be held subject to all the provisions of the Certificate of Incorporation and all amendments thereto and
resolutions of the Board of Directors providing for the issue of shares of Common Stock (copies of which may be obtained from the secretary of the Corporation), to all of which the holder of this certificate by acceptance hereof assents. 

FOR VALUE RECEIVED,
                                        
                                        
                                        
     HEREBY SELL, ASSIGN AND TRANSFER UNTO 
 PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE 
  

	
	
	  

	
	  

  

	
	  

	 (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS,
 INCLUDING 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:	 	  

  

 2 

			
		 	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.
	 Signature(s) Guaranteed:
	 	
		
	  
	 	
	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).	 	

 The holder of this certificate shall be entitled to receive funds from the trust fund only in the
event of the Corporation’s liquidation upon failure to consummate a business combination or if the holder seeks to convert his respective shares into cash upon a business combination which he voted against and which is actually completed by the
Corporation. In no other circumstances shall the holder have any right or interest of any kind in or to the trust fund. 
  

 3Specimen Warrant Certificate

 EXHIBIT 4.3 
 FORM OF WARRANT 
 THIS WARRANT CERTIFICATE (I) CANNOT BE TRANSFERRED OR EXCHANGED UNTIL THE EARLIER TO
OCCUR OF THE EXPIRATION OF THE UNDERWRITER’S OPTION TO PURCHASE UP TO 2,343,750 ADDITIONAL UNITS TO COVER OVER-ALLOTMENTS OR THE EXERCISE IN FULL BY THE UNDERWRITER OF SUCH OPTION (THE “DETACHMENT DATE”) UNLESS INCLUDED WITH A
SHARE OF COMMON STOCK OF GOLDEN POND HEALTHCARE, INC. AS PART OF A UNIT AND (II) CANNOT BE EXERCISED IN WHOLE OR IN PART UNTIL THE LATER OF THE COMPANY’S COMPLETION OF A BUSINESS COMBINATION AND
[                    ], 2008 [ONE YEAR FROM THE EFFECTIVE DATE OF THE REGISTRATION STATEMENT]. 
 EXERCISABLE ONLY IF COUNTERSIGNED BY THE WARRANT AGENT AS PROVIDED HEREIN. 
 Warrant Certificate evidencing 
 Warrants to Purchase Common Stock, par value $0.001, as described herein.

 GOLDEN POND HEALTHCARE, INC. 
  

			
	 No.
                    
	  	CUSIP No. [                    ]

 VOID AFTER 5:00 P.M., NEW YORK CITY TIME, ON
[                    ], 2011, 
 OR
UPON EARLIER REDEMPTION 
 This certifies that
                                        ,
or its registered assigns, is the registered holder of
                                        
warrants to purchase certain securities (each a “WARRANT”). Each Warrant entitles the holder thereof, subject to the provisions contained herein and in the Warrant Agreement (as defined below), to purchase from Golden Pond Healthcare,
Inc., a Delaware corporation (the “COMPANY”), one share of the Company’s Common Stock (each a “SHARE”), at the Exercise Price set forth below. The exercise price of each Warrant (the “EXERCISE PRICE”) shall be
$             initially, subject to adjustments as set forth in the Warrant Agreement. 
 Subject to the terms of the Warrant Agreement, each Warrant evidenced hereby may be exercised in whole, but not in part, at any time, as specified herein, on any Business Day (as defined below) occurring during the
period (the “EXERCISE PERIOD”) (A) commencing on the later of (i) the Company’s completion of a Business Combination (as defined below) (ii) and
[                    ], 2008 and (B) ending at 5:00 P.M., New York City time, on the earlier to occur of
(i) [                    ], 2011 and (ii) the Redemption Date (the “EXPIRATION DATE”). Each Warrant remaining unexercised
after 5:00 P.M., New York City time on the Expiration Date shall become void, and all rights of the holder of this Warrant Certificate evidencing such Warrant shall cease. 
 The holder of the Warrants represented by this Warrant Certificate may exercise any Warrant evidenced hereby by delivering, not later than
5:00 P.M., New York City time, on 

 
any Business Day during the Exercise Period (the “EXERCISE DATE”) to Continental Stock Transfer & Trust Company (the “WARRANT
AGENT”, which term includes any successor warrant agent under the Warrant Agreement described below) at its corporate trust department at 17 Battery Place, New York, NY 10004, (i) this Warrant Certificate, (ii) an election to
purchase (“ELECTION TO PURCHASE”), properly executed by the holder hereof on the reverse of this Warrant Certificate (the “PARTICIPANT”) substantially in the form included on the reverse of hereof, as applicable and
(iii) the Exercise Price for each Warrant to be exercised in lawful money of the United States of America by certified or official bank check or by bank wire transfer in immediately available funds[; PROVIDED, HOWEVER, that the holder of this
Warrant Certificate may, in lieu of payment of the Exercise Price, surrender its Warrants for that number of shares of Common Stock equal to the quotient obtained by dividing (x) the product of the number of shares of Common Stock underlying
the surrendered Warrants, multiplied by the difference between the Fair Market Value (defined below) and the Exercise Price by (y) the Fair Market Value. The “FAIR MARKET VALUE” shall mean the average reported last sale price of the
Common Stock for the 10 trading days ending on the 3rd trading day prior to the date on which the Election to Purchase is sent to the Warrant Agent].1 If
any of (a) this Warrant Certificate, (b) the Election to Purchase, or (c) the Exercise Price therefor [or surrendered Warrants],2 is
received by the Warrant Agent after 5:00 P.M., New York City time, the Warrants will be deemed to be received and exercised on the Business Day next succeeding the date such items are received and such date shall be the Exercise Date for
purposes hereof. If the date such items are received is not a Business Day, the Warrants will be deemed to be received and exercised on the next succeeding day which is a Business Day and such date shall be the Exercise Date. If the Warrants to be
exercised are received or deemed to be received after the Expiration Date, the exercise thereof will be null and void and any funds delivered to the Warrant Agent will be returned to the holder as soon as practicable. In no event will interest
accrue on funds deposited with the Warrant Agent in respect of an exercise or attempted exercise of Warrants. The validity of any exercise of Warrants will be determined by the Warrant Agent in its sole discretion and such determination will be
final and binding upon the holder of the Warrants and the Company. Neither the Warrant Agent nor the Company shall have any obligation to inform a holder of Warrants of the invalidity of any exercise of Warrants. 
 As used herein, the term “BUSINESS DAY” means any day that is not a Saturday or Sunday and is not a United States federal holiday or a day on
which banking institutions generally are authorized or obligated by law or regulation to close in New York City. 
 As used herein, the term
“BUSINESS COMBINATION” shall have the meaning set forth in the Warrant Agreement. 
  

	 1
	 To be included only in Warrant Certificates representing Warrants issued in the
private placement. 

	 2
	 To be included only in Warrant Certificates representing Warrants issued in the
private placement. 

  

 2 

 Warrants may be exercised only in whole numbers of Warrants. No fractional shares of Common Stock are to
be issued upon the exercise of any Warrant, but rather the number of shares of Common Stock to be issued shall be rounded up to the nearest whole number. If fewer than all of the Warrants evidenced by this Warrant Certificate are exercised, a new
Warrant Certificate for the number of Warrants remaining unexercised shall be delivered to the holder of this Warrant Certificate at the address specified on the books of the Warrant Agent or as otherwise specified by such Registered Holder.

 Notwithstanding the foregoing, the Company shall not be obligated to deliver any Shares pursuant to the exercise of a Warrant and shall
have no obligation to settle a Warrant exercise unless a registration statement under the Securities Act of 1933, as amended (the “SECURITIES ACT”), with respect to the Shares is effective and a current prospectus is on file with the
Commission. In the event that a registration statement with respect to the Shares underlying a Warrant is not effective under the Securities Act or a current prospectus is not on file with the Commission, the holder of such Warrant shall not be
entitled to exercise such Warrant. Notwithstanding anything to the contrary in the Warrant Agreement (as defined below) and this Warrant Certificate, under no circumstances will the Company be required to net cash settle a Warrant exercise. Warrants
may not be exercised by, or Shares issued to, any registered holder in any state in which such exercise or issuance would be unlawful. For the avoidance of doubt, as a result of Section 3.3.3 of the Warrant Agreement and the foregoing, any or
all of the Warrants may expire unexercised. 
 This Warrant Certificate is issued under and in accordance with the Warrant Agreement, dated
as of [                    ], 2007 (the “WARRANT AGREEMENT”), between the Company and the Warrant Agent and is subject to the terms
and provisions contained in the Warrant Agreement, to all of which terms and provisions the holder of this Warrant Certificate and the beneficial owners of the Warrants represented by this Warrant Certificate consent by acceptance hereof. Copies of
the Warrant Agreement are on file and can be inspected at the above-mentioned office of the Warrant Agent and at the office of the Company at 18 Arrowhead Way, Darien, CT 06820. 
 At any time during the Exercise Period, the Company may, at its option, redeem all (but not part) of the then outstanding Warrants upon giving notice in
accordance with the terms of the Warrant Agreement (the “REDEMPTION NOTICE”), at the price of $0.01 per Warrant (the “REDEMPTION PRICE”); PROVIDED, that the last sales price of the Shares has been at least $11.50 per
Share (subject to adjustment as provided in the Warrant Agreement), on any twenty (20) trading days within a thirty (30) trading day period ending on the third Business Day prior to the date on which the Redemption Notice is given. In the
event the Company shall elect to redeem all of the then outstanding Warrants, the Company shall fix a date for such redemption (the “REDEMPTION DATE”). The Warrants may be exercised in accordance with the terms of this Agreement at any
time after a Redemption Notice shall have been given by the Company; PROVIDED, HOWEVER, that no Warrants may be exercised subsequent to the expiration of the Exercise Period; PROVIDED, FURTHER, that all rights whatsoever with respect to the Warrants
shall cease on the Redemption Date, other than to the right to receive the Redemption Price. 
  

 3 

 The accrual of dividends, if any, on the Shares issued upon the valid exercise of any Warrant will be
governed by the terms generally applicable to such Shares. From and after the issuance of such Shares, the former holder of the Warrants exercised will be entitled to the benefits generally available to other holders of Shares and such former
holder’s right to receive payments of dividends and any other amounts payable in respect of the Shares shall be governed by, and shall be subject to, the terms and provisions generally applicable to such Shares. 
 The Exercise Price and the number of Shares purchasable upon the exercise of each Warrant shall be subject to adjustment as provided pursuant to
Section 4 of the Warrant Agreement. 
 Prior to the Detachment Date, the Warrants represented by this Warrant Certificate may be
exchanged or transferred only together with the Shares to which such Warrant is attached (together, a “UNIT”), and only for the purpose of effecting, or in conjunction with, an exchange or transfer of such Unit. Additionally, prior to the
Detachment Date, each transfer of such Unit on the register of the Units shall operate also to transfer the Warrants included in such Units. From and after the Detachment Date, the above provisions shall be of no further force and effect. Upon due
presentment for registration of transfer or exchange of this Warrant Certificate at the stock transfer division of the Warrant Agent, the Company shall execute, and the Warrant Agent shall countersign and deliver, as provided in Section 5 of
the Warrant Agreement, in the name of the designated transferee one or more new Warrant Certificates of any authorized denomination evidencing in the aggregate a like number of unexercised Warrants, subject to the limitations provided in the Warrant
Agreement. 
 Neither this Warrant Certificate nor the Warrants evidenced hereby shall entitle the holder hereof or thereof to any of the
rights of a holder of the Shares, including, without limitation, the right to receive dividends, if any, or payments upon the liquidation, dissolution or winding up of the Company or to exercise voting rights, if any. 
 The Warrant Agreement and this Warrant Certificate may be amended as provided in the Warrant Agreement including, under certain circumstances described
therein, without the consent of the holder of this Warrant Certificate or the Warrants evidenced hereby. 
 THIS WARRANT CERTIFICATE AND ALL
RIGHTS HEREUNDER AND UNDER THE WARRANT AGREEMENT SHALL BE GOVERNED BY AND INTERPRETED AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK APPLICABLE TO CONTRACTS FORMED AND TO BE PERFORMED ENTIRELY WITHIN THE STATE OF NEW YORK,
WITHOUT REGARD TO THE CONFLICTS OF LAW PROVISIONS THEREOF TO THE EXTENT SUCH PRINCIPLES OR RULES WOULD REQUIRE OR PERMIT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION. 
 This Warrant Certificate shall not be entitled to any benefit under the Warrant Agreement or be valid or obligatory for any purpose, and no Warrant
evidenced hereby may be exercised, unless this Warrant Certificate has been countersigned by the manual or facsimile signature of the Warrant Agent. 
  

 4 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed. 
 Dated as of                     
            , 2007 
  

							
		 		 	Golden Pond Healthcare, Inc.
				
		 		 	By:	 	  

		 		 		 	Authorized Officer
	 Continental Stock Transfer & Trust Company,
   as Warrant Agent
	 		 	
				
	 By:
	 	  
	 		 	
		 	Authorized Officer	 		 	

  

 5 

 [REVERSE] 
 INSTRUCTIONS FOR EXERCISE OF WARRANT 
 To exercise
the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Warrant Agent at the office of the Warrant Agent, or at the office of its successor as Warrant
Agent, in the Borough of Manhattan, City of New York cash, a certified or official bank check or a wire transfer in immediately available funds, in each case payable to the Warrant Agent at Account
No.             , in an amount equal to the Exercise Price in full for the Warrants exercised[; PROVIDED, HOWEVER, that the holder of this Warrant Certificate may, in lieu of
payment of the Exercise Price for the Warrants, surrender its Warrants for that number of shares of Common Stock equal to the quotient obtained by dividing (x) the product of the number of shares of Common Stock underlying the surrendered
Warrants, multiplied by the difference between the Fair Market Value and the Exercise Price by (y) the Fair Market Value].3 In addition, the Warrant
holder or Participant must provide the information required below and deliver this Warrant Certificate to the Warrant Agent at the address set forth below. The Warrant Certificate and this Election to Purchase must be received by the Warrant Agent
by 5:00 P.M., New York time, on the specified Exercise Date. 
 ELECTION TO PURCHASE 
 TO BE EXECUTED IF WARRANT HOLDER DESIRES 
 TO
EXERCISE THE WARRANTS EVIDENCED HEREBY 
 The undersigned hereby irrevocably elects to
exercise, on                     ,              (the “EXERCISE
DATE”),                      Warrants, evidenced by this Warrant Certificate, to purchase, _________________ of the shares of Common
Stock (each a “SHARE”) of Golden Pond Healthcare, Inc., a Delaware corporation (the “COMPANY”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by cash, certified or official
bank check or bank wire transfer in immediately available funds to the order of the Company c/o Continental Stock Transfer & Trust Company, 17 Battery Place, New York, New York 10004, in the amount of
$                     in accordance with the terms hereof [or, at the election of the holder, the holder (in lieu of payment of the Exercise
Price for the Warrants) has surrendered Warrants for that number of shares of Common Stock equal to the quotient obtained by dividing (x) the product of the number of shares of Common Stock underlying the surrendered Warrants, multiplied by the
difference between the Fair Market Value and the Exercise Price by (y) the Fair Market Value in accordance with the terms hereof].4 The undersigned
requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. 
  

	 3
	 To be included only in Warrant Certificates representing Warrants issued in the
private placement. 

	 4
	 To be included only in Warrant Certificates representing Warrants issued in the
private placement. 

 If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests
that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. 
  

							
	 Dated:
	 	                         ,
            	  		 	
				
	 Name
	 	  
	  	(Please Print)	 	
			
	 /    /    /    /  -  /    /    /  - 
 /    /    /    /    /                 
   
	  		 	
	 (Insert Social Security
 or Other Identifying Number of Holder)
	  	Address	 	  

		 		  		 	  

	 Signature
	 	  
	  		 	

 This Warrant may only be exercised by presentation to the Warrant Agent at one of the following
locations: 
 By hand at: 
 By
mail at: 
 The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this
Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed
to assure timely delivery. 
 (Instructions as to form and delivery of Shares and/or Warrant Certificates) 
  

			
	Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate:	 	  

		
	Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent:	 	  

		 	(Street Address)
		
		 	  

		 	(City and State) (Zip Code)
		
	Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate:	 	  

  

 7 

			
	Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books
of the Warrant Agent:	  	  

		  	(Street Address)
		  	  

		  	(City and State) (Zip Code)
		
		  	Dated:
		
		  	  

		  	Signature
		
		  	SIGNATURE MUST CONFORM IN ALL RESPECTS TO THE NAME OF THE HOLDER AS SPECIFIED ON THE FACE OF THIS WARRANT CERTIFICATE. IF SHARES, OR A WARRANT CERTIFICATE EVIDENCING UNEXERCISED WARRANTS, ARE TO
BE ISSUED IN A NAME OTHER THAN THAT OF THE REGISTERED HOLDER HEREOF OR ARE TO BE DELIVERED TO AN ADDRESS OTHER THAN THE ADDRESS OF SUCH HOLDER AS SHOWN ON THE BOOKS OF THE WARRANT AGENT, THE ABOVE SIGNATURE MUST BE GUARANTEED BY AN ELIGIBLE
GUARANTOR INSTITUTION (AS THAT TERM IS DEFINED IN RULE 17AD-15 OF THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED).

					
		
	 SIGNATURE GUARANTEE
	  	
			
	 Name of Firm
	 	  
	  	
	 Address
	 	  
	  	
	 Area Code
         and Number
	 	  
	  	
	 Authorized
         Signature
	 	  
	  	

					
	 Name
	 	  
	  	
	 Title
	 	  
	  	
	 Dated:
	 	                     ,
20    
	  	

  

 8 

 ASSIGNMENT 
 (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER 
 DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY)

 FOR VALUE
RECEIVED,                                      
                                        
                                        
       HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO
                                        
                                        

  

			
	  
	  	  

	 (Please print name and address
 including zip code of assignee)
	  	 (Please insert social security or
 other identifying
number of assignee)

 the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint
____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. 
  

			
	 Dated:
	  	  

		  	Signature
		
		  	(SIGNATURE MUST CONFORM IN ALL RESPECTS TO THE NAME OF THE HOLDER AS SPECIFIED ON THE FACE OF THIS WARRANT CERTIFICATE AND MUST BEAR A SIGNATURE GUARANTEE BY AN ELIGIBLE GUARANTOR INSTITUTION
(AS THAT TERM IS DEFINED IN RULE 17AD-15 OF THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED).

					
	
	 SIGNATURE GUARANTEE

			
	 Name of Firm:
	 	  
	  	
	 Address:
	 	  
	  	
	 Area Code
         and Number:
	 	  
	  	
	 Authorized
         Signature:
	 	  
	  	

					
	 Name:
	 	  
	  	
	 Title:
	 	  
	  	
	 Dated:
	 	                    , 20

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