Pursuant to section 8-403 and 8-405 of the Uniform Commercial Code, you are notified that I am the owner of the following described shares of Corporation:
Certificate number:
Class of shares: common
Number of shares:
On or about , the certificate was . The certificate was indorsed .
I request that you do not transfer the shares on the books of the corporation.
If this certificate is presented, please notify me as follows: