Certificate	№ {No]	For [Number] Shares Issued to	[Shareholder Name]	Dated [Month] [date], [Year] From whom transferred	Dated
№. Original Certificate	№. Original Shares	№. Shares Transferred
Received Certificate №. {No] For [Number] Shares This day of	№	{No]	Shares	[Number]
[Company Name]	This Certifies that [Shareholder Name] is the registered holder of [Number] Shares of the Capital Stock transferable only on the books of the Corporation by the holder hereof in person or by Attorney upon surrender of this Certificate properly endorsed.	In Witness Whereof, the said Corporation has caused this Certificate to be signed by its duly authorized officers and its Corporate Seal is to be hereunto affixed this [date] day of [Month] , A.D. [Year] .
For Value Received,	hereby sell, assign and transfer unto	Shares represented by the within Certificate, and do hereby irrevocably constitute and appoint	Attorney to transfer the said Shares on the books of the within named Corporation with full power of substitution in the premises.	Dated	In presence of