Exhibit 4.1
ANNEXON, INC.
PRE-FUNDED WARRANT TO PURCHASE COMMON STOCK
Number of Shares: []
(subject to adjustment)
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Warrant No. [] |
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Original Issue Date: December 26, 2023 |
Annexon, Inc., a Delaware corporation (the Company), hereby certifies that, for good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, [] or its permitted registered assigns (the Holder), is entitled, subject to the terms set forth below, to purchase from the Company up to a total
of [] shares of common stock, $0.001 par value per share (the Common Stock), of the Company (each such share, a Warrant Share and all such shares, the Warrant Shares) at an exercise
price per share equal to $0.001 per share (as adjusted from time to time as provided in Section 9 herein, the Exercise Price), upon surrender of this Pre-Funded Warrant to Purchase
Common Stock (including any Warrants to Purchase Common Stock issued in exchange, transfer or replacement hereof, the Warrant) at any time and from time to time on or after the date hereof (the Original Issue
Date), until the Warrant has been exercised in full, and subject to the following terms and conditions:
1 DEFINITIONS.
For purposes of this Warrant, the following terms shall have the following meanings:
(a) Affiliate means any Person directly or
indirectly controlled by, controlling, or under common control with, a Holder, but only for so long as such control shall continue. For purposes of this definition, control (including, with correlative meanings, controlled
by, controlling and under common control with) means, with respect to a Person, possession, direct or indirect, of (a) the power to direct or cause direction of the management and policies of such Person (whether
through ownership of securities or partnership or other ownership interests, by contract or otherwise), or (b) at least 50% of the voting securities (whether directly or pursuant to any option, warrant, or other similar arrangement) or other
comparable equity interests.
(b) Commission means the United States Securities and Exchange Commission.
(c) Exchange Act means the Securities Exchange Act of 1934, as amended.
(d) Principal Trading Market means the national securities exchange or other trading market on which the Common Stock is primarily listed
and quoted for trading, which, as of the Original Issue Date, shall be The Nasdaq Global Market.
(e) Registration Statement means the
Companys registration statement on Form S-3 (File No. 333-258863), which was filed, and became effective, on May 3, 2022.
(f) Securities Act means the Securities Act of 1933, as amended.
(g) Trading Day means any weekday on which the Principal Trading Market is open for trading.
(h) Transfer Agent means American Stock Transfer & Trust Company, the Companys transfer agent and registrar for the Common
Stock, and any successor appointed in such capacity.
(i) VWAP means, for any date, the price determined by the first of the following
clauses that applies: (i) if the Common Stock is then listed or quoted on a national securities exchange or other trading market, the daily volume weighted average price of the Common Stock for such date (or the nearest preceding date) on the
Principal Trading Market as reported by Bloomberg L.P. (based on a Trading Day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City time)), (ii) if the Common Stock is then listed or quoted for trading and neither OTCQB nor OTCQX is the
Principal Trading Market, the volume weighted average price of the Common Stock for such date (or the nearest preceding date) on OTCQB or OTCQX, as applicable, (iii) if the Common Stock is not then listed or quoted for trading on OTCQB or OTCQX
and if prices for the Common Stock are then reported in the Pink Sheets published by OTC Markets Group, Inc. (or a similar organization or agency succeeding to its functions of reporting prices), the most recent bid price per
share of the Common Stock so reported, or (iv) in all other cases, the fair market value of a share of Common Stock as determined by an independent appraiser selected in good faith by the Holder and reasonably acceptable to the Company, the
fees and expenses of which shall be paid by the Company.