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As Of Filer Filing For·On·As Docs:Size Issuer Agent 10/05/18 Axonics Modulation Techs, Inc. S-1 39:6.7M Donnelley … Solutions/FA |
Document/Exhibit Description Pages Size 1: S-1 Registration Statement (General Form) HTML 1.64M 2: EX-3.1 Articles of Incorporation/Organization or By-Laws HTML 75K 3: EX-3.2 Articles of Incorporation/Organization or By-Laws HTML 17K 4: EX-3.3 Articles of Incorporation/Organization or By-Laws HTML 14K 5: EX-3.4 Articles of Incorporation/Organization or By-Laws HTML 19K 6: EX-3.6 Articles of Incorporation/Organization or By-Laws HTML 65K 7: EX-4.1 Instrument Defining the Rights of Security Holders HTML 29K 8: EX-4.2 Instrument Defining the Rights of Security Holders HTML 134K 9: EX-4.3 Instrument Defining the Rights of Security Holders HTML 52K 10: EX-4.4 Instrument Defining the Rights of Security Holders HTML 50K 11: EX-10.1 Material Contract HTML 158K 18: EX-10.13 Material Contract HTML 242K 19: EX-10.14 Material Contract HTML 20K 20: EX-10.15 Material Contract HTML 18K 21: EX-10.16 Material Contract HTML 175K 22: EX-10.17 Material Contract HTML 44K 23: EX-10.18 Material Contract HTML 44K 24: EX-10.19 Material Contract HTML 43K 12: EX-10.2 Material Contract HTML 38K 25: EX-10.20 Material Contract HTML 43K 26: EX-10.21 Material Contract HTML 44K 27: EX-10.22 Material Contract HTML 44K 28: EX-10.23 Material Contract HTML 44K 29: EX-10.24 Material Contract HTML 40K 30: EX-10.25 Material Contract HTML 44K 31: EX-10.26 Material Contract HTML 28K 32: EX-10.27 Material Contract HTML 23K 33: EX-10.28 Material Contract HTML 19K 34: EX-10.29 Material Contract HTML 17K 13: EX-10.3 Material Contract HTML 26K 35: EX-10.30 Material Contract HTML 52K 14: EX-10.4 Material Contract HTML 12K 15: EX-10.5 Material Contract HTML 67K 16: EX-10.6 Material Contract HTML 69K 17: EX-10.7 Material Contract HTML 59K 37: EX-21.1 Subsidiaries HTML 12K 38: EX-23.1 Consent of Experts or Counsel HTML 11K 39: EX-99.1 Miscellaneous Exhibit HTML 12K 36: EX-16.1 Letter re: Change in Certifying Accountant HTML 11K
| EX-4.1 |
| Exhibit 4.1 ZQ|CERT#|COY|CLS|RGSTRY|ACCT#|TRANSTYPE|RUN#|TRANS# COMMON STOCKCOMMON STOCK PAR VALUE $0.0001 Certificate Number ZQ00000000 AXONICS MODULATION TECHNOLOGIES, INC. INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE Shares * * 000000 ****************** * * * 000000 ***************** **** 000000 **************** ***** 000000 *************** ****** 000000 ************** THIS CERTIFIES THAT is the owner of SEE REVERSE FOR CERTAIN DEFINITIONS THIS CERTIFICATE IS TRANSFERABLE IN CITIES DESIGNATED BY THE TRANSFER AGENT, AVAILABLE ONLINE AT www.computershare.com FULLY-PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK OF Axonics Modulation Technologies, 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 bylaws, 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. FACSIMILE SIGNATURE TO COME President FACSIMILE SIGNATURE TO COME Secretary DATED DD-MMM-YYYY COUNTERSIGNED AND REGISTERED: COMPUTERSHARE TRUST COMPANY, N.A. TRANSFERAGENT ANDREGISTRAR, By AUTHORIZEDSIGNATURE PO BOX 43004, Providence, RI 02940-3004 MR A SAMPLE DESIGNATION (IF ANY) ADD 1 ADD 2 ADD 3 ADD 4 CUSIP/IDENTIFIER 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 111 1234567890/1234567890 222 1234567890/1234567890 333 1234567890/1234567890 444 1234567890/1234567890 555 1234567890/1234567890 666 Total Transaction 7
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AXONICS MODULATION TECHNOLOGIES, INC.
THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER 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: |
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| 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) | |||||||||
| ..................under Uniform Transfers to Minors Act....................... | ||||||||||
| (Minor) (State) | ||||||||||
| Additional abbreviations may also be used though not in the above list.
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| PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE | ||
| For value received, hereby sell, assign and transfer unto |
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(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE, OF ASSIGNEE) | ||
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Shares | |
| of the common stock represented by the within Certificate, and do hereby irrevocably constitute and appoint | ||
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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. |
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| Signature: |
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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. |
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The IRS requires that the named transfer agent (“we”) report the cost basis of certain shares or units acquired after January 1, 2011. If your shares or units are covered by the legislation, and you requested to sell or transfer the shares or units using a specific cost basis calculation method, then we have processed as you requested. If you did not specify a cost basis calculation method, then we have defaulted to the first in, first out (FIFO) method. Please consult your tax advisor if you need additional information about cost basis.
If you do not keep in contact with the issuer or do not have any activity in your account for the time period specified by state law, your property may become subject to state unclaimed property laws and transferred to the appropriate state.
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| This ‘S-1’ Filing | Date | Other Filings | ||
|---|---|---|---|---|
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| Filed on: | 10/5/18 | None on these Dates | ||
| 1/1/11 | ||||
| List all Filings | ||||
As Of Filer Filing For·On·As Docs:Size Issuer Filing Agent 4/29/24 Axonics, Inc. 10-K/A 12/31/23 13:1.1M 2/29/24 Axonics, Inc. 10-K 12/31/23 88:24M 5/05/23 Axonics, Inc. S-3ASR 5/05/23 5:916K 3/07/23 Axonics, Inc. S-8 3/07/23 4:104K 3/01/23 Axonics, Inc. 10-K 12/31/22 82:25M 3/01/22 Axonics, Inc. 10-K 12/31/21 79:14M 3/01/21 Axonics, Inc. 10-K 12/31/20 80:13M |
