FORM 8-A
Washington, D.C. 20549
For registration of certain classes of securities
Pursuant to section 12(b) or (g) of the
Securities Exchange Act of 1934
DOCTORSURF.COM, INC.
(Exact name of registrant as specified in its charter)
Florida 59-3569844
(State of incorporation (I.R.S. Employer
or organization) Identification No.)
6925 112TH Circle North, Suite 101, Largo, Florida 33773
(Address of principal executive offices) (Zip Code)
Securities to be registered pursuant to Section 12(b) of the Act:
Title of each class Name of each exchange on which
to be so registered Each class is to be registered
None
If this form relates to the registration of a class of securities pursuant to
Section 12(b) of the Exchange Act and is effective pursuant to General
Instruction A.(c), check the following box. [_]
If this form relates to the registration of a class of securities pursuant to
Section 12(g) of the Exchange Act and is effective pursuant to General
Instruction A.(d), check the following box. [X]
Securities Act registration statement file number to which this form relates:
(if applicable) 333-80475
Securities to be registered pursuant to Section 12(g) of the Act.
Common Stock, $.01 par value
(Title of class)
<PAGE>
Item 1. Description of Registrant's Securities to be Registered.
The Registrant hereby incorporates by reference herein the description
of the Registrant's Common Stock in the Prospectus contained in the Registrant's
Registration Statement on Form SB-2, as filed with the Securities and Exchange
Commission on June 11, 1999 under Commission File No. 333-80475 (as amended from
time to time, the "Registration Statement"). The form of the Company's Articles
of Incorporation, as amended, and By-laws are filed as Exhibit 3.1 and 3.2,
respectively, to the Registration Statement.
Item 2. Exhibits
The following exhibits are filed as part of this registration
statement.
2(a) Amendment No. 6 to the Registration Statement (File No.
333-80475), as filed with the Securities and Exchange Commis-
sion on November 5, 1999 and incorporated by reference herein.
2(b) Articles of Incorporation.(1)
2(c) Bylaws.(2)
2(d) Copy of form of stock certificate for the Registrant's Common
Stock.
____________________
(1) Incorporated herein by reference to Exhibit 3.1 of the Registration State-
ment No. 333-80475 filed with the Securities and Exchange Commission on
June 11, 1999, as amended.
(2) Incorporated herein by reference to Exhibit 3.2 of the Registration State-
ment No. 333-80475 filed with the Securities and Exchange Commission on
June 11, 1999, as amended.
2
<PAGE>
SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange Act of
1934, the registrant has duly caused this registration statement to be signed on
its behalf by the undersigned, thereto duly authorized.
Date: November 12, 1999
DOCTORSURF.COM, INC.
By: /s/ Rakesh K. Sharma
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Name: Rakesh K. Sharma, M.D.
Its: President
3
Number DOCTORSURF.COM, INC. Shares
Internet Medicine
Common Stock CUSIP 25614V 10 6
Incorporated Under the Laws of the State of
Florida See Reverse Side for Certain
Definitions
THIS CERTIFIES THAT
IS THE OWNER OF
FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK, PAR VALUE $.01 of
DoctorSurf.com, Inc., a corporation incorporated under the laws of the State of
Florida, transferable on the books of DoctorSurf.com, Inc. in person or by duly
authorized attorney upon surrender of this Certificate properly endorsed. This
Certificate is not valie until countersigned and registered by the Transfer
Agent and Registrar.
IN WITNESS WHEREOF, DoctorSurf.com, Inc. has caused this Certificate to
be executed by the the facsimile signatures of its duly authorized officers and
sealed with the facsimile seal of DoctorSurf.com, Inc.
DoctorSurf.com, Inc.
Corporate
Seal
1999
Florida
Dated:
/s/ Jugal K. Taneja /s/ Rakesh K. Sharma
Secretary President
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Controller: DoctorSurf.com, Inc.
<PAGE>
THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO
REQUESTS, THE DESIGNATIONS, POWERS, PREFERENCES, AND RELATIVE, PARTICIPATING,
OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE CORPORATION AND
THE VARIATIONS IN RIGHTS, PREFERENCES, AND LIMITATIONS DETERMINED FOR EACH
SERIES (AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR
FUTURE SERIES). SUCH REQUEST MAY BE MADE TO THE CORPORATION AT ITS PRINCIPAL
OFFICE.
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:
TEN COM - as tenants in common
TEN ENT - as tenants by the entireties
JT TEN - as joint tenants with right
of survivorship and not as tenants
in common
UNIF GIFT MIN ACT-D Custodian
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(Cust) (Minor)
under Uniform Gifts to Minors
Act
---------------------------------
(State)
Additional abbreviations may also be used though not in the above list.
For value received,___________________________hereby sell, assign and
transfer unto
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE
- --------------------------------
- --------------------------------
- --------------------------------------------------------------------------------
(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE OF ASSIGNEE)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Shares
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of the Common Stock represented by the within Certificate, and do hereby
irrevocably constitute and appoint
Attorney
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to transfer the said stock on the books of the within-named Corporation with
full power of substitution in the premises.
Dated
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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.
SIGNATURE(S) GUARANTEED:
--------------------------------------------
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.
KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, MUTILATED OR
DESTROYED, THE CORPORATION WILL REQUIRE A BOND OF INDEMNITY AS A CONDITION TO
THE ISSUANCE OF A REPLACEMENT CERTIFICATE.
