Assignment And Transfer Of Share Certificate

FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfers to (----) of the shares of (Corporation) standing in the name of the undersigned on the books of the Corporation and represented by Certificate No.

The undersigned hereby and irrevocably constitutes and appoints _______________________ (attorney), to transfer the said shares on the books of the within named Company with full power of substitution in the premises.

Dated:

___________________________

In the presence of:

____________________________

FORM4

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