Exhibit 4.1
016570| 003590|127C|RESTRICTED||4|057-423
COMMON STOCK COMMON STOCK
PAR VALUE $0.01 THIS CERTIFICATE IS TRANSFERABLE IN
CANTON, MA, OR JERSEY CITY, NJ
CERTIFICATE
NUMBER SHARES
ZQ 000412 EPIX Pharmaceuticals **600620******
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE ***600620*****
****600620****
*****600620***
******600620**
THIS CERTIFIES THAT MR. SAMPLE & MRS. SAMPLE & CUSIP 26881Q 30 9
MR. SAMPLE & MRS. SAMPLE SEE REVERSE FOR CERTAIN
DEFINITIONS
is the owner of *** SIX HUNDRED THOUSAND
SIX HUNDRED AND TWENTY***
FULLY PAID AND NONASSESSABLE SHARES OF THE COMMON STOCK,
PAR VALUE $0.01 PER SHARE, OF
EPIX PHARMACEUTICALS, INC. (THE "CORPORATION"), transferable on the books of the
Corporation in person or by duly authorized attorney upon surrender of this
Certificate properly endorsed or assigned. This Certificate and the shares
represented hereby are issued and held subject to laws of the State of Delaware
and to the provisions of the Certificate of Incorporation and By-Laws of the
Corporation, each as now in effect or hereafter amended. This Certificate is not
valid unless countersigned and registered by the Transfer Agent and Registrar.
IN WITNESS WHEREOF, the Corporation has caused this Certificate to be executed
by the facsimile signatures of its duly authorized officers and sealed with the
facsimile seal of the Corporation.
(SEAL OF EPIX DATED <<Month Day, Year>>
PHARMACEUTICALS INC.)
/s/ Illegible (CORPORATE DELAWARE COUNTERSIGNED AND REGISTERED:
- ------------------------------------- 1988) COMPUTERSHARE TRUST COMPANY, N.A.
President TRANSFER AGENT AND REGISTRAR,
/s/ Illegible By
- ------------------------------------- -------------------------------------
Treasurer and Chief Financial Officer AUTHORIZED SIGNATURE
SECURITY INSTRUCTIONS ON REVERSE
CUSIP XXXXXX XX X
HOLDER ID XXXXXXXXXX
EPIX Pharmaceuticals INSURANCE VALUE 1,000,000.00
NUMBER OF SHARES 123456
PO BOX 43004, PROVIDENCE, RI 02940-3004 DTC 12345678 123456789012345
CERTIFICATE NUMBERS NUM/NO. DENOM. TOTAL
------------------- ------- ------ -----
MR A SAMPLE 1234567890/1234567890 1 1 1
DESIGNATION (IF ANY) 1234567890/1234567890 2 2 2
ADD 1 1234567890/1234567890 3 3 3
ADD 2 1234567890/1234567890 4 4 4
ADD 3 1234567890/1234567890 5 5 5
ADD 4 1234567890/1234567890 6 6 6
TOTAL TRANSACTION 7
EPIX PHARMACEUTICALS, INC.
THE CORPORATION IS AUTHORIZED TO ISSUE MORE THAN ONE CLASS AND SERIES OF STOCK. THE CORPORATION WILL FURNISH TO THE HOLDER UPON
WRITTEN REQUEST WITHOUT CHARGE 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 )
and not as tenants in common -------------------- ----- ----------
(Cust) (Minor)
under Uniform Transfers to Minors Act
----------
(State)
Additional abbreviations may also be used though not in the above list.
PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE
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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 Corporation with full power of substitution in the premises.
Dated: 20 Signature(s) Guaranteed: Medallion Guarantee Stamp
------------------------------------------ -------------------- THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE
GUARANTOR INSTITUTION (Banks, Stockbrokers, Savings and
Loan Associations and Credit Unions) WITH MEMBERSHIP IN
Signature: AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM,
------------------------------------------------------------ PURSUANT TO S.E.C. RULE 17Ad-15.
Signature:
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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 EXCEPT WITHOUT NOTING
WATERMARK HOLD TO LIGHT TO VERIFY WATERMARK