EX-10.12






 Exhibit 10.12 

SATSUMA PHARMACEUTICALS, INC. 

CHANGE IN CONTROL AND SEVERANCE AGREEMENT 

This Change in Control and Severance Agreement (the “Agreement”) is made and entered into by and between
[                    ] (“Executive”) and Satsuma Pharmaceuticals, Inc. (the “Company”), effective as
of [the latest date set forth by the signatures of the parties hereto below]/[the date Executive commences employment with the Company] (the “Effective Date”). 

Background 

A.    The Board of Directors of the Company (the “Board”) recognizes that the possibility of an
acquisition of the Company or an involuntary termination can be a distraction to Executive and can cause Executive to consider alternative employment opportunities. The Board has determined that it is in the best interests of the Company and its
stockholders to assure that the Company will have the continued dedication and objectivity of Executive, notwithstanding the possibility, threat or occurrence of such an event. 

B.    The Board believes that it is in the best interests of the Company and its stockholders to provide Executive with an
incentive to continue Executive’s employment and to motivate Executive to maximize the value of the Company upon a Change in Control (as defined below) for the benefit of its stockholders. 

C.    The Board believes that it is imperative to provide Executive with severance benefits upon certain terminations of
Executive’s service to the Company that enhance Executive’s financial security and provide incentive and encouragement to Executive to remain with the Company notwithstanding the possibility of such an event. 

D.    Unless otherwise defined herein, capitalized terms used in this Agreement are defined in Section 9 below. 

Agreement 
 The parties
hereto agree as follows: 
 1.    Term of Agreement. This Agreement shall become effective as of the Effective
Date and terminate upon the date that all obligations of the parties hereto with respect to this Agreement have been satisfied. 

2.    At-Will Employment. The Company and Executive acknowledge that
Executive’s employment is and shall continue to be “at-will,” as defined under applicable law. Except as provided in Section 5 below, if Executive’s employment terminates for any
reason, Executive shall not be entitled to any severance payments, benefits or compensation other than as provided in this Agreement. 













 3.    Covered Termination Outside a Change in Control Period. If
Executive experiences a Covered Termination outside a Change in Control Period, then, subject to (i) Executive delivering to the Company an executed general release of all claims against the Company and its affiliates in a form approved by the
Company (a “Release of Claims”) that becomes effective and irrevocable in accordance with Section 14(a)(v) below, or such shorter period of time specified by the Company,
following such Covered Termination and (ii) Executive’s continued compliance with Section 12 below, then in addition to any accrued but unpaid salary, benefits, vacation and expense reimbursements through the Termination Date payable
in accordance with applicable law, the Company shall provide Executive with the following: 
 (a)    Severance.
During the period of time commencing on the Termination Date and ending on the [            ] ([    ])month anniversary of the Termination Date, the Company shall
continue to pay Executive his/her base salary at the rate in effect immediately prior to the Termination Date. Such payments shall be made in accordance with the Company’s standard payroll practices, less applicable withholdings, beginning on
the first payroll date following the date the Release of Claims becomes effective and irrevocable in accordance with Section 14(a)(v) below, and with the first installment including any amounts that would have been paid had the Release of
Claims been effective and irrevocable on the Termination Date. 
 (b)    Continued Healthcare. If Executive
timely elects to receive continued healthcare coverage pursuant to the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (“COBRA”), the Company shall directly pay, or reimburse Executive
for, the Company’s portion of the premium (at the same rates in effect on the Termination Date) for Executive and Executive’s covered dependents through the earlier of (i) the
[            ] ([    ])month anniversary of the Termination Date and (ii) the date Executive and Executive’s covered dependents, if any, become eligible for
healthcare coverage under another employer’s plan(s). Notwithstanding the foregoing, (i) if any plan pursuant to which such benefits are provided is not, or ceases prior to the expiration of the period of continuation coverage to be,
exempt from the application of Section 409A of the Internal Revenue Code of 1986, as amended, (the “Code”) under Treasury Regulation Section 1.409A-1(a)(5), or (ii) the
Company is otherwise unable to continue to cover Executive under its group health plans without penalty under applicable law (including without limitation, Section 2716 of the Public Health Service Act), then, in either case, an amount equal to
each remaining Company subsidy shall thereafter be paid to Executive in substantially equal monthly installments. After the Company ceases to pay premiums pursuant to this Section 3(b), Executive may, if eligible, elect to continue healthcare
coverage at Executive’s expense in accordance with the provisions of COBRA. Executive shall notify the Company immediately if Executive becomes covered by a group health plan of a subsequent employer. 

  
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 4.    Covered Termination During a Change in Control Period. If
Executive experiences a Covered Termination during a Change in Control Period, then, subject to (i) Executive delivering to the Company an executed Release of Claims that becomes effective and irrevocable in accordance with
Section 14(a)(v) below, or such shorter period of time specified by the Company, following such Covered Termination and (ii) Executive’s continued compliance with Section 12 below, then in addition to any accrued but unpaid
salary, benefits, vacation and expense reimbursements through the Termination Date payable in accordance with applicable law, the Company shall provide Executive with the following: 

(a)    Severance. During the period of time commencing on the Termination Date and ending on the
[            ] ([    ])month anniversary of the Termination Date, the Company shall continue to pay Executive his/her base salary at the rate in effect immediately prior
to the Termination Date. Such payments shall be made in accordance with the Company’s standard payroll practices, less applicable withholdings, beginning on the first payroll date following the date the Release of Claims becomes effective and
irrevocable in accordance with Section 14(a)(v) below, and with the first installment including any amounts that would have been paid had the Release of Claims been effective and irrevocable on the Termination Date. 

(b)    Target Bonus. Executive shall be entitled to receive an amount equal to
[            ] ([    ])months of Executive’s target annual bonus assuming achievement of performance goals at one hundred percent (100%) of target at the rate in
effect immediately prior to the Termination Date, payable in a cash lump sum, less applicable withholdings, on the first payroll date following the date the Release of Claims becomes effective and irrevocable becomes effective and irrevocable in
accordance with Section 14(a)(v) below. 
 (c)    Continued Healthcare. If Executive timely elects to
receive continued healthcare coverage pursuant to the provisions of COBRA, the Company shall directly pay, or reimburse Executive for, the Company’s portion of the premium (at the same rates in effect on the Termination Date) for Executive and
Executive’s covered dependents through the earlier of (i) the [            ] ([    ])month anniversary of the Termination Date and (ii) the date Executive
and Executive’s covered dependents, if any, become eligible for healthcare coverage under another employer’s plan(s). Notwithstanding the foregoing, (i) if any plan pursuant to which such benefits are provided is not, or ceases prior
to the expiration of the period of continuation coverage to be, exempt from the application of Section 409A of the Code under Treasury Regulation Section 1.409A-1(a)(5), or (ii) the Company is
otherwise unable to continue to cover Executive under its group health plans without penalty under applicable law (including without limitation, Section 2716 of the Public Health Service Act), then, in either case, an amount equal to each
remaining Company subsidy shall thereafter be paid to Executive in substantially equal monthly installments. After the Company ceases to pay premiums pursuant to this Section 4(c), Executive may, if eligible, elect to continue healthcare
coverage at Executive’s expense in accordance with the provisions of COBRA. Executive shall notify the Company immediately if Executive becomes covered by a group health plan of a subsequent employer. 

(d)    Equity Awards. Each outstanding and unvested equity award (excluding any such awards that vest in whole or
in part based on the attainment of performance-vesting conditions), including, without limitation, each restricted stock, stock option, restricted stock unit and stock appreciation right, held by Executive shall automatically become vested and, if
applicable, exercisable and any forfeiture restrictions or rights of repurchase thereon shall immediately lapse with respect to one percent (100%) of the shares subject thereto (excluding any such awards that vest in whole or in part based on the
attainment of performance-vesting conditions, which shall be governed by the terms of the applicable award agreement), as of immediately prior to the Termination Date. To give effect to the foregoing, upon the Termination Date, (i) the vested
portion of such equity awards shall be remain outstanding and/or be exercisable for the period(s) of time set forth in the applicable equity award agreements, (ii) Executive’s outstanding equity awards shall cease vesting, and
(iii) the unvested shares subject to Employee’s outstanding equity awards shall 

  
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remain outstanding (but unvested) until the earlier to occur of (A) the original expiration date of the equity award and (B) three (3) month anniversary of the Date of Termination (the
“Equity Award Period”). In the event a Change in Control has not been consummated by end of the Equity Award Period, then the unvested portion of Executive’s equity awards shall terminate immediately without further action as
of such date. 
 5.    Certain Reductions. Notwithstanding anything herein to the contrary, the Company shall
reduce Executive’s severance benefits under this Agreement, in whole or in part, by any other severance benefits, pay in lieu of notice, or other similar benefits payable to Executive by the Company in connection with Executive’s
termination, including but not limited to payments or benefits pursuant to (a) any applicable legal requirement, including, without limitation, the Worker Adjustment and Retraining Notification Act, or (b) any other Company agreement,
arrangement, policy or practice relating to Executive’s termination of employment with the Company. The benefits provided under this Agreement are intended to satisfy, to the greatest extent possible, any and all statutory obligations that may
arise out of Executive’s termination of employment. Such reductions shall be applied on a retroactive basis, with severance benefits paid first in time being recharacterized as payments pursuant to the Company’s statutory obligation. 

6.    Deemed Resignation. Upon termination of Executive’s service for any reason, Executive shall be deemed to
have resigned from all offices and directorships, if any, then held with the Company or any of its affiliates, and, at the Company’s request, Executive shall execute such documents as are necessary or desirable to effectuate such resignations.

 7.    Other Terminations. If Executive’s employment with the Company terminates for any reason other than
due to a Covered Termination, then Executive shall not be entitled to any benefits hereunder other than accrued but unpaid salary, vacation and expense reimbursements through the Termination Date in accordance with applicable law and to elect any
continued healthcare coverage as may be required under COBRA or similar state law. 
 8.    Limitation on
Payments. Notwithstanding anything in this Agreement to the contrary, if any payment or distribution Executive would receive pursuant to this Agreement or otherwise (“Payment”) would (a) constitute a “parachute
payment” within the meaning of Section 280G of the Code and (b) but for this sentence, be subject to the excise tax imposed by Section 4999 of the Code (the “Excise Tax”), then such Payment shall either be
(i) delivered in full, or (ii) delivered as to such lesser extent which would result in no portion of such Payment being subject to the Excise Tax, whichever of the foregoing amounts, taking into account the applicable federal, state and
local income taxes and the Excise Tax, results in the receipt by Executive on an after-tax basis, of the largest payment, notwithstanding that all or some portion the Payment may be taxable under
Section 4999 of the Code. The Company will select an adviser with experience in performing calculations regarding the applicability of Section 280G of the Code and the Excise Tax, provided, that the adviser’s determination
shall be made based upon “substantial authority” within the meaning of Section 6662 of the Code to perform the foregoing calculations. The Company shall bear all expenses with respect to the determinations by such adviser required to
be made hereunder. The adviser shall provide its calculations to the Company and Executive within fifteen (15) calendar days after the date on which Executive’s right to a Payment is triggered (if requested at that time by the Company or
Executive) or such other time as requested by the Company. Any good faith 

  
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determinations of the adviser made hereunder shall be final, binding and conclusive upon the Company and Executive. Any reduction in payments or benefits pursuant to this Section 8 will
occur in the following order: (1) reduction of cash payments; (2) cancellation of accelerated vesting of equity awards other than stock options; (3) cancellation of accelerated vesting of stock options; and (4) reduction of other
benefits payable to Executive. 
 9.    Definitions. The following terms used in this Agreement shall have the
following meanings: 
 (a)    “Cause” means the occurrence of any of the following:
(i) Executive’s willful and continued failure to perform his or her material duties to the Company that goes uncured after notice from the [Company/Board]; (ii) Executive’s willful or intentional conduct that causes or is expected to
cause material and demonstrable injury, monetarily or otherwise, to the Company; or (iii) Executive’s conviction of, or a plea of nolo contendere to, a crime constituting (A) a felony under the laws of the United States or any
state thereof, or (B) a misdemeanor involving moral turpitude. 
 (b)    “Change in
Control” has the meaning ascribed to such term under the Company’s 2019 Equity Incentive Plan, as amended; provided, that such transaction must also constitute a “change in control event” within the meaning of
Treasury Regulation Section 1.409A-3(i)(5). 
 (c)    “Change in
Control Period” means the period of time commencing three (3) months prior to the consummation of a Change in Control and ending on the twelve (12) month anniversary of such Change in Control. 

(d)    “Covered Termination” means the termination of Executive’s employment by the Company
other than for Cause or by Executive for Good Reason, in each case that, to the extent necessary, constitutes a Separation from Service. 

(e)    “Good Reason” means the occurrence of any of the following events or conditions, without
the Executive’s express written consent (which consent may be denied, withheld or delayed for any reason): 

(i)    a material reduction in Executive’s duties, authority or responsibilities; 

(ii)    [a requirement that Executive report to a corporate officer or employee instead of directly to the Board;] 

(iii)    a material reduction by the Company in Executive’s annual base salary or annual bonus or incentive
compensation opportunity as in effect as of the Effective Date or as the same may be increased from time to time; 

  
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 (iv)    a requirement by the [Company/Board] that Executive’s
principal place of employment relocate to a location more than thirty (30) miles from Executive’s principal place of employment immediately prior to his or her termination or the Company’s requiring Executive to be based anywhere
other than such principal place of employment (or permitted relocation thereof) except for required travel on the Company’s business to an extent substantially consistent with travel requirements standard and customary in the industry; or 

(v)    any action or inaction that constitutes an uncured, material breach by the Company of this Agreement or any other
agreement between the Company and Executive, or any uncured, material breach by the Company of a policy relating to the benefits to which Executive is entitled. 

Executive must provide notice to the Company of the condition giving rise to ”Good Reason” within ninety (90) days of the
initial existence of such condition and the Company will have thirty (30) days following such notice to remedy such condition and Executive’s resignation for Good Reason must occur within thirty (30) days following the expiration of
such cure period if the Company did not remedy such condition. Executive’s right to terminate Executive’s employment for Good Reason will not be affected by Executive’s incapacity due to physical or mental illness. Executive’s
continued employment will not constitute consent to, or a waiver of rights with respect to, any act or failure to act constituting Good Reason hereunder. 

(f)    “Separation from Service” means a “separation from service” with the Company
within the meaning of Section 409A of the Code and the Department of Treasury regulations and other guidance promulgated thereunder. 

(g)    “Termination Date” means the date on which Executive experiences a Covered Termination.

 10.    Successors. 

(a)    Company’s Successors. Any successor to the Company (whether direct or indirect and whether by purchase,
merger, consolidation, liquidation or otherwise) to all or substantially all of the Company’s business or assets shall assume the obligations under this Agreement and agree expressly to perform the obligations under this Agreement in the same
manner and to the same extent as the Company would be required to perform such obligations in the absence of a succession. For all purposes under this Agreement, the term “Company” shall include any successor to the Company’s
business or assets which executes and delivers the assumption agreement described in this Section 10(a) or which becomes bound by the terms of this Agreement by operation of law. 

(b)    Executive’s Successors. The terms of this Agreement and all rights of Executive hereunder shall inure
to the benefit of, and be enforceable by, Executive’s personal or legal representatives, executors, administrators, successors, heirs, distributees, devisees and legatees. 

  
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 11.    Notices. Any notices provided hereunder must be in writing
and shall be deemed effective upon the earlier of personal delivery (including personal delivery by facsimile), delivery by email or the third day after mailing by first class mail, to the Company at its primary office location and to Executive at
Executive’s address as listed in the Company’s books and records. 
 12.    Confidentiality; Non-Disparagement. 
 (a)    Confidentiality. Executive hereby expressly
confirms Executive’s continuing obligations to the Company pursuant to that certain confidentiality agreement by and between the Company and Executive (the “Confidential Information Agreement”). 

(b)    Non-Disparagement. Executive agrees that Executive shall not
disparage, criticize or defame the Company, its affiliates and their respective affiliates, directors, officers, agents, partners, stockholders or employees, either publicly or privately. Nothing in this Section 12(b) shall apply to any
evidence or testimony required by any court, arbitrator or government agency. 
 (c)    Whistleblower Protections and
Trade Secrets. Notwithstanding anything to the contrary contained herein, nothing in this Agreement or the Confidentiality Agreement prohibits Executive from reporting possible violations of federal law or regulation to any United States
governmental agency or entity in accordance with the provisions of and rules promulgated under Section 21F of the Securities Exchange Act of 1934 or Section 806 of the Sarbanes-Oxley Act of 2002, or any other whistleblower protection
provisions of state or federal law or regulation (including the right to receive an award for information provided to any such government agencies). Furthermore, in accordance with 18 U.S.C. § 1833, notwithstanding anything to the contrary in
this Agreement: (i) Executive shall not be in breach of this Agreement, and shall not be held criminally or civilly liable under any federal or state trade secret law (A) for the disclosure of a trade secret that is made in confidence to a
federal, state, or local government official or to an attorney solely for the purpose of reporting or investigating a suspected violation of law, or (B) for the disclosure of a trade secret that is made in a complaint or other document filed in
a lawsuit or other proceeding, if such filing is made under seal; and (ii) if Executive files a lawsuit for retaliation by the Company for reporting a suspected violation of law, Executive may disclose the trade secret to Executive’s
attorney, and may use the trade secret information in the court proceeding, if Executive files any document containing the trade secret under seal, and does not disclose the trade secret, except pursuant to court order. 

13.    Dispute Resolution. Unless otherwise prohibited by law or specified below, all disputes, claims and causes
of action, in law or equity, arising from or relating to this Agreement or to Executive’s employment or the termination thereof (each, a “Claim”) shall be resolved solely and exclusively by final and binding arbitration
held in San Mateo County, California through JAMS under its Employment Arbitration Rules and Procedures, which are available at www.jamsadr.com/rules-employment-arbitration. The arbitrator shall: (a) provide adequate discovery for the
resolution of the dispute; and (b) issue a written arbitration decision, to include the arbitrator’s essential findings and conclusions and a statement of the award. Except to the extent of filing fees Executive would incur were the matter
to be litigated in court, the Company shall be responsible for the JAMS administrative fees and the arbitrator’s fees and costs. The arbitrator shall award the prevailing party attorneys’ fees and expert fees, if any. The parties agree to
abide by all decisions and awards rendered in such proceedings. Such decisions and awards rendered by the 

  
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arbitrator shall be final and conclusive. All such controversies, claims or disputes shall be settled in this manner in lieu of any action at law or equity; provided, however, that
nothing in this subsection shall be construed as precluding the bringing of an action for injunctive relief or specific performance as provided in this Agreement or the Confidential Information Agreement. This dispute resolution process and any
arbitration hereunder shall be confidential and neither any party nor the neutral arbitrator shall disclose the existence, contents or results of such process without the prior written consent of all parties, except where necessary or compelled in a
court to enforce this arbitration provision or an award from such arbitration or otherwise in a legal proceeding. Executive and the Company understand that by agreeing to arbitrate any claim pursuant to this Section 13, they will not have the
right to have any claim decided by a jury or a court, but shall instead have any claim decided through arbitration. Executive and the Company waive any constitutional or other right to bring claims covered by this Agreement other than in their
individual capacities. Except as may be prohibited by applicable law, the foregoing waiver includes the ability to assert claims as a plaintiff or class member in any purported class or representative proceeding. Notwithstanding the foregoing,
Executive and the Company each have the right to resolve any issue or dispute over intellectual property rights by court action instead of arbitration. 

14.    Miscellaneous Provisions. 

(a)    Section 409A. 

(i)    Separation from Service. Notwithstanding any provision to the contrary in this Agreement, no amount
constituting deferred compensation subject to Section 409A of the Code shall be payable pursuant to Sections 3 or 4 above unless Executive’s termination of employment constitutes a Separation from Service. 

(ii)    Specified Employee. Notwithstanding any provision to the contrary in this Agreement, if Executive is
deemed at the time of his Separation from Service to be a “specified employee” for purposes of Section 409A(a)(2)(B)(i) of the Code, to the extent delayed commencement of any portion of the benefits to which Executive is entitled
under this Agreement is required in order to avoid a prohibited distribution under Section 409A(a)(2)(B)(i) of the Code, such portion of Executive’s benefits shall not be provided to Executive prior to the earlier of (A) the
expiration of the six-month period measured from the date of Executive’s Separation from Service or (B) the date of Executive’s death. Upon the first business day following the expiration of the
applicable Code Section 409A(a)(2)(B)(i) period, all payments deferred pursuant to this Section 14(a)(ii) shall be paid in a lump sum to Executive, and any remaining payments due under this Agreement shall be paid as otherwise provided
herein. 
 (iii)    Expense Reimbursements. To the extent that any reimbursements payable pursuant to this
Agreement are subject to the provisions of Section 409A of the Code, any such reimbursements payable to Executive pursuant to this Agreement shall be paid to Executive no later than December 31 of the year following the year in which the
expense was incurred, the amount of expenses reimbursed in one year shall not affect the amount eligible for reimbursement in any subsequent year, and Executive’s right to reimbursement under this Agreement will not be subject to liquidation or
exchange for another benefit. 

  
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 (iv)    Installments. For purposes of Section 409A of the
Code (including, without limitation, for purposes of Treasury Regulation Section 1.409A-2(b)(2)(iii)), Executive’s right to receive any installment payments under this Agreement shall be treated as a
right to receive a series of separate payments and, accordingly, each such installment payment shall at all times be considered a separate and distinct payment. 

(v)    Release. Notwithstanding anything to the contrary in this Agreement, to the extent that any payments due
under this Agreement as a result of Executive’s termination of employment are subject to Executive’s execution and delivery of a Release of Claims, (A) the Company shall deliver the Release of Claims to Executive within ten
business days following Executive’s Termination Date, and the Company’s failure to deliver a Release of Claims prior to the expiration of such ten business day period shall constitute a waiver of any requirement to execute a
Release of Claims, (B) if Executive fails to execute the Release of Claims on or prior to the Release Expiration Date (as defined below) or timely revokes Executive’s acceptance of the Release of Claims thereafter, Executive shall not be
entitled to any payments or benefits otherwise conditioned on the Release of Claims, and (C) in any case where Executive’s Termination Date and the Release Expiration Date fall in two separate taxable years, any payments required to be
made to Executive that are conditioned on the Release of Claims and are treated as nonqualified deferred compensation for purposes of Section 409A of the Code shall be made in the later taxable year. For purposes hereof, “Release
Expiration Date” shall mean (1) if Executive is under 40 years old as of the Termination Date, the date that is seven (7) days following the date upon which the Company timely delivers the Release of Claims to Executive, or
such shorter time prescribed by the Company, and (2) if Executive is 40 years or older as of the Termination Date, the date that is twenty one (21) days following the date upon which the Company timely delivers the Release of Claims to
Executive, or, if Executive’s termination of employment is “in connection with an exit incentive or other employment termination program” (as such phrase is defined in the Age Discrimination in Employment Act of 1967), the date that
is forty five (45) days following such delivery date. To the extent that any payments of nonqualified deferred compensation (within the meaning of Section 409A) due under this Agreement as a result of Executive’s termination of
employment are delayed pursuant to this Section 14(a)(v), such amounts shall be paid in a lump sum on the first payroll date following the date that Executive executes and does not revoke the Release of Claims (and the applicable revocation
period has expired) or, in the case of any payments subject to Section 14(a)(v)(C), on the first payroll date to occur in the subsequent taxable year, if later. 

(b)    Withholding. The Company shall be entitled to withhold from any amounts payable under this Agreement any
federal, state, local, or foreign withholding or other taxes or charges which the Company is required to withhold. 

(c)    Waiver. No provision of this Agreement shall be modified, waived or discharged unless the modification,
waiver or discharge is agreed to in writing and signed by Executive and by an authorized member of the Company (other than Executive). No waiver by either party of any breach of, or of compliance with, any condition or provision of this Agreement by
the other party shall be considered a waiver of any other condition or provision or of the same condition or provision at another time. 

  
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 (d)    Whole Agreement. This Agreement and the Confidential
Information Agreement represent the entire understanding of the parties hereto with respect to the subject matter hereof and supersede all prior promises, arrangements and understandings regarding the same, whether written or unwritten, including,
without limitation, any severance or change in control benefits in Executive’s offer letter agreement, employment agreement and/or equity award agreement or previously approved by the Company. 

(e)    Choice of Law. All questions concerning the construction, validity and interpretation of this Agreement will
be governed by the laws of the State of California without regard to its conflicts of law provisions. 

(f)    Severability. Whenever possible, each provision of this Agreement will be interpreted in such manner as to
be effective and valid under applicable law, but if any provision of this Agreement is held to be invalid or unenforceable in any respect under any applicable law or rule in any jurisdiction, such invalidity or unenforceability will not affect any
other provision or any other jurisdiction, but this Agreement will be reformed, construed and enforced in such jurisdiction as if such invalid or unenforceable provisions had never been contained herein. 

(g)    Counterparts. This Agreement may be executed in separate counterparts, any one of which need not contain
signatures of more than one party, but all of which taken together will constitute one and the same Agreement. 

(h)    Executive Acknowledgement. Executive acknowledges that (i) Executive has consulted with or has had the
opportunity to consult with independent counsel of Executive’s own choice concerning this Agreement, and has been advised to do so by the Company, and (ii) that Executive has read and understands the Agreement, is fully aware of its legal
effect, and has entered into it freely based on Executive’s own judgment. 
 (Signature page follows) 

  
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 The parties have executed this Agreement, in the case of the Company by its duly authorized officer, as of
the dates set forth below. 
  

			
	SATSUMA PHARMACEUTICALS, INC.


 
			
		
	By:	 	  

	Title:	 	  

	Date:	 	  



 
			
	
	EXECUTIVE


  

			
	  

	[Name]	 	
		
	Date:	 	  




  
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