Exhibit 4.1
SG161 XXXXXX COMPUTERSHARE MR A SAMPLE MR B SAMPLE MR C SAMPLE MR D SAMPLE MR E SAMPLE THE PAVILIONS BRIDGWATER ROAD BRISTOL BS99 2GE All correspondence to: Computershare Investor Services PLC The Pavilions Bridgwater Road Bristol BS99 6ZZ Shareholder Helpline: +44 (0) 870 702 0000 You can check your holding at www.investorcentre.co.uk Share Certificate - Ordinary Shares of £0.001 Given under the signatures of a Director and the Company Secretary Shareholder Reference Number C0123456789 ISIN Certificate Class Broker Code Location Code GB00BVYV1687 OR1 250 C A company incorporated under the Companies Act 2006 in England and Wales with registered number 09338148 Certificate Class OR1 Certificate No. 00032471 This certificate must be surrendered before any transfer of the whole or part of the shares herein mentioned can be registered. Registrar and Transfer Office: Computershare Investor Services PLC, The Pavilions, Bridgwater Road, Bristol BS99 6ZZ, Shareholder Helpline: +44 (0) 870 702 0000. You can check your holding at: www.investorcentre.co.uk L A M Number of Shares Issued 27 September 2002 **17000** This is to certify that MR A SAMPLE MR B SAMPLE MR C SAMPLE MR D SAMPLE MR E SAMPLE is/are the Registered Holder(s) of seventeen thousand Ordinary Shares of £0.001, fully paid, in Adaptimmune Therapeutics plc subject to the Articles of Association of the Company. Adaptimmune Therapeutics plc Adaptimmune Therapeutics plc 001CS001_9999_CERT_SAMPLE/000001/000001/SG161/i *00000101010000* 000001 27 September 2002 seventeen thousand **17000** *17000* |
Please check that your address details printed overleaf are correct. If you need to make any alterations or you are planning to move, you can let us know by registering with Investor Centre at www.investorcentre.co.uk. Once registered you can select the "Change of Address" option to amend your address details. Alternatively you can complete and sign the form below. Kindly Note: This form is issued only to the addressee(s) and is specific to the class of security and the unique designated account printed hereon. This personalised form is not transferable between different (i) account holders; (ii) classes of security; or (iii) uniquely designated accounts. The Company and Computershare Investor Services PLC accept no liability for any instruction that does not comply with these conditions. Computershare Investor Services PLC is Registered in England & Wales, No 3498808, Registered Office, The Pavilions, Bridgwater Road, Bristol BS13 8AE. Computershare Investor Services PLC is authorised and regulated by the Financial Conduct Authority In the case of joint holders ALL must sign. In the case of a corporation this form should be signed by two authorised signatories (e.g. Director & Company Secretary) stating their capacity. Alternatively, this form can be signed by a director of the company in the presence of a witness who attests the signature or under its common seal. T D A C0123456789 Computershare Investor Services PLC is Registered in England & Wales, No 3498808, Registered Office, The Pavilions, Bridgwater Road, Bristol BS13 8AE. Computershare Investor Services PLC is authorised and regulated by the Financial Conduct Authority Reference No. C0123456789 *C0123456789 Transfer No. GDT0077492 DUPLICATE Certificate No. 00032471 LSTSC *00032471* Number of Shares **17000** *00000017000* Date DD/MM/YY Signature (1) Signature (2) Signature (3) Signature (4) House Number Post Code Street/Road Name (BLOCK CAPITALS) Town/CITY (BLOCK CAPITALS) Country (BLOCK CAPITALS) |