Form of Fixed Rate Medium-Term Note, Series N





 Exhibit 4.47 

[FORM OF FIXED RATE MEDIUM-TERM NOTE, SERIES N] 

(Face of Security) 
 [IF
A GLOBAL SECURITY, INSERT — THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE EXCHANGED IN WHOLE OR IN
PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SECURITY IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE.]

 [IF DTC IS THE DEPOSITARY, INSERT — UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY
TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), TO THE GOLDMAN SACHS GROUP, INC., OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER
NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR
OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN.] 

[INSERT ANY LEGEND REQUIRED BY THE INTERNAL REVENUE CODE AND THE REGULATIONS THEREUNDER.] 

[INSERT ANY LEGEND REQUIRED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT AND THE REGULATIONS THEREUNDER.] 

THIS SECURITY IS NOT A BANK DEPOSIT AND IS NOT INSURED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION OR ANY OTHER GOVERNMENTAL AGENCY, NOR
IS IT AN OBLIGATION OF, OR GUARANTEED BY, A BANK. 

  
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 CUSIP No.
                     
 THE
GOLDMAN SACHS GROUP, INC. 
 MEDIUM-TERM NOTES, SERIES N 

(Fixed Rate) 
 The
following terms apply to this Security, as and to the extent shown below: 

 

 PRINCIPAL AMOUNT: 

STATED MATURITY DATE: 
 SPECIFIED CURRENCY: U.S.
dollars for all payments unless otherwise specified below: 
  

	 	•	 	payments of principal and any premium: 

  

	 	•	 	payments of interest: 

  

	 	•	 	Exchange Rate Agent: 

 INTEREST RATE:     % per annum 

INTEREST PAYMENT DATE(S):  

                    , subject to the provisions under
“Payments Due on a Business Day” below 
 ORIGINAL ISSUE DATE*: 

DAY COUNT CONVENTION: 
 OTHER TERMS:



 ORIGINAL ISSUE DISCOUNT SECURITY: 

 

	 	•	 	Total Amount of OID: 

  

	 	•	 	Yield to Maturity: 

  

	 	•	 	Initial Accrual Period OID: 

 REDEMPTION COMMENCEMENT DATE: 

REPAYMENT DATE(S): 
 REDEMPTION OR REPAYMENT PRICE(S):

 DEFEASANCE: 
  

	 	•	 	Full Defeasance: 

  

	 	•	 	Covenant Defeasance: 

 BUSINESS DAY CONVENTION: 

 

 

  
 [*    This date shall
be the issue date of this Security, unless there is a Predecessor Security, in which case this date shall be the issue date of the first Predecessor Security.] 

Terms left blank or marked “N/A”, “No”, “None” or in a similar manner do not apply to this Security except as
otherwise may be specified. 
 Whenever used in this Security, the terms specified above that apply to this Security have the meanings
specified above, unless the context requires otherwise. Other terms used in this Security that are not defined herein but that are defined in the Indenture referred to in Section 1 on the reverse of this Security are used herein as defined
therein. 

  
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 The Goldman Sachs Group, Inc., a corporation duly organized and existing under the laws of
the State of Delaware (hereinafter called the “Company”, which term includes any successor Person under the Indenture), for value received, hereby promises to pay to
                        , or registered assigns, as principal the Principal Amount on the Stated Maturity Date and to pay
interest thereon, from the Original Issue Date or from the most recent Interest Payment Date to which interest has been paid or made available for payment, on the Interest Payment Date(s) in each year, commencing on the first such date specified on
the face of this Security, and at the Maturity of the principal hereof, at the rate per annum equal to the Interest Rate specified on the face hereof, until the principal hereof is paid or made available for payment. Any premium and any such
installment of interest that is overdue at any time shall also bear interest (to the extent that the payment of such interest shall be legally enforceable) at the rate per annum at which the principal then bears interest, from the date any such
overdue amount first becomes due until it is paid or made available for payment. Notwithstanding the foregoing, interest on any principal, premium or installment of interest that is overdue shall be payable on demand, subject to the provisions in
the Indenture. 
 On each Interest Payment Date or at the Maturity of the principal hereof, the amount of interest payable will equal the
Principal Amount hereof multiplied by an accrued interest factor for the Interest Period. The Interest Period will be the period from and including [Insert Original Issue Date], or the last date to which interest has been paid or made
available for payment, to but excluding such Interest Payment Date or Maturity, as the case may be (subject to “Payments Due on a Business Day” below). The accrued interest factor will equal the Interest Rate specified on the face hereof
multiplied by the Day Count Convention specified on the face hereof for the applicable Interest Period. 
 The applicable Day Count
Convention is specified on the face hereof and means: 
 (i)    if “1/1 (ISDA)” or
“1/1” is specified, 1; 
 (ii)    if “Actual/Actual”, “Actual/Actual
(ISDA)”, “Act/Act” or “Act/Act (ISDA)” is specified, the actual number of days in the Interest Period divided by 365 (or, if any portion of that Interest Period falls in a leap year, the sum of (1) the
actual number of days in that portion of the Interest Period falling in a leap year divided by 366 and (2) the actual number of days in that portion of the Interest Period falling in a non-leap
year divided by 365); 
 (iii)    if “Actual/Actual (ICMA)” or “Act/Act
(ICMA)” is specified, the number of days in the Interest Period, including February 29 in a leap year, divided by the product of (1) the actual number of days in such Interest Period and (2) the number of Interest Periods
in the year; 
 (iv)    if “Actual/365 (Fixed)”, “Act/365 (Fixed)”, “A/365
(Fixed)” or “A/365F” is specified, the actual number of days in the Interest Period divided by 365; 

  
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 (v)    if “Actual/360 (ISDA)”, “Act/360
(ISDA)”, “A/360 (ISDA)”, “Actual/360”, “Act/360” or “A/360” is specified, the actual number of days in the Interest Period divided by 360; 

(vi)    if “30/360 (ISDA)”, “360/360 (ISDA)”, “Bond Basis (ISDA)”,
“30/360”, “360/360” or “Bond Basis” is specified, the number of days in the Interest Period in respect of which payment is being made divided by 360, calculated on a formula basis as follows: 

 

	
	 [360×(Y2–Y1)]+[30×(M2–M1)]+(D2–D
1)
 360


 where 
  

	 	•	 	 “Y1” is the year, expressed as a number, in
which the first day of the Interest Period falls; 


  

	 	•	 	 “Y2” is the year, expressed as a number, in
which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “M1” is the calendar month, expressed as a
number, in which the first day of the Interest Period falls; 


  

	 	•	 	 “M2” is the calendar month, expressed as a
number, in which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “D1” is the first calendar day, expressed as a
number, of the Interest Period, unless such number would be 31, in which case D1 will be 30; and 


  

	 	•	 	 “D2” is the calendar day, expressed as a
number, immediately following the last day included in the Interest Period, unless such number would be 31 and D1 is greater than 29, in which case D2 will be 30; and 


 (vii)    if
“30E/360” or “Eurobond Basis” is specified, the number of days in the Interest Period in respect of which payment is being made divided by 360, calculated on a formula basis as follows: 

 

	
	 [360×(Y2–Y1)]+[30×(M2–M1)]+(D2–D
1)
 360


 where 
  

	 	•	 	 “Y1” is the year, expressed as a number, in
which the first day of the Interest Period falls; 



  
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	 	•	 	 “Y2” is the year, expressed as a number, in
which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “M1” is the calendar month, expressed as a
number, in which the first day of the Interest Period falls; 


  

	 	•	 	 “M2” is the calendar month, expressed as a
number, in which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “D1” is the first calendar day, expressed as a
number, of the Interest Period, unless such number would be 31, in which case D1 will be 30; and 


  

	 	•	 	 “D2” is the calendar day, expressed as a
number, immediately following the last day included in the Interest Period, unless such number would be 31, in which case D2 will be 30; and 



(viii)    if “30E/360 (ISDA)” is specified, the number of days in the Interest Period in respect
of which payment is being made divided by 360, calculated on a formula basis as follows: 
  

	
	 [360×(Y2–Y1)]+[30×(M2–M1)]+(D2–D
1)
 360


 where 
  

	 	•	 	 “Y1” is the year, expressed as a number, in
which the first day of the Interest Period falls; 


  

	 	•	 	 “Y2” is the year, expressed as a number, in
which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “M1” is the calendar month, expressed as a
number, in which the first day of the Interest Period falls; 


  

	 	•	 	 “M2” is the calendar month, expressed as a
number, in which the day immediately following the last day included in the Interest Period falls; 


  

	 	•	 	 “D1” is the first calendar day, expressed as a
number, of the Interest Period, unless (1) that day is the last day of February or (2) such number would be 31, in which cases D1 will be 30; and 



 

	 	•	 	 “D2” is the calendar day, expressed as a
number, immediately following the last day included in the Interest Period, unless (1) that day is the last day of February, but not the stated maturity date or (2) such number would be 31, in which cases D2 will be 30. 



  
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 The interest so payable, and punctually paid or made available for payment, on any Interest
Payment Date will, as provided in the Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the [if Global Security, insert — calendar day (whether
or not a Business Day (as defined in Section 3 on the reverse hereof))] [if not a Global Security, insert alternative provision acceptable to Trustee and Registrar] immediately preceding the day on which payment is to be made (as such
payment date may be adjusted in accordance with the Business Day Convention specified on the face hereof and the second paragraph under “Payments Due on a Business Day” below) (a “Regular Record Date”). Any interest so
payable, but not punctually paid or made available for payment, on any Interest Payment Date will forthwith cease to be payable to the Holder on such Regular Record Date and such Defaulted Interest may either be paid to the Person in whose name this
Security (or one or more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof being given to the Holder of this Security not
less than 10 days prior to such Special Record Date, or be paid in any other lawful manner not inconsistent with the requirements of any securities exchange on which this Security may be listed, and upon such notice as may be required by such
exchange, all as more fully provided in the Indenture. For the purpose of determining the Holder at the close of business on any relevant record date when business is not being conducted, the close of business will mean 5:00 P.M., New York City
time, on that day. 
 All percentages resulting from any calculation with respect to this Security will be rounded upward or downward, as
appropriate, to the next higher or lower one hundred-thousandth of a percentage point (e.g., 9.876541% (or .09876541) being rounded down to 9.87654% (or .0987654) and 9.876545% (or .09876545) being rounded up to 9.87655% (or
..0987655)). All amounts used in or resulting from any calculation with respect to this Security will be rounded upward or downward, as appropriate, to the nearest cent, in the case of U.S. dollars, or to the nearest corresponding hundredth of a
unit, in the case of a currency other than U.S. dollars, with one-half cent or one-half of a corresponding hundredth of a unit or more being rounded upward. 

Currency of Payment 
 Payment of
principal of (and premium, if any) and interest on this Security will be made in the Specified Currency for such payment, except as provided in this and the next three paragraphs. The Specified Currency for any payment shall be the currency
specified as such on the face of this Security unless, at the time of such payment, such currency is not legal tender for the payment of public and private debts in the country issuing such currency on the Original Issue Date, in which case the
Specified Currency for such payment shall be such coin or currency as at the time of such payment is legal tender for the payment of public and private debts in such country, except as provided in the next sentence. If the euro is specified on the
face of this Security as the Specified Currency for any payment, the Specified Currency for such payment shall be such coin or currency as at the time of payment is legal tender for the payment of public and private debts in all EMU Countries (as
defined in Section 3 on the reverse hereof), provided that, if on any day there are not at least two EMU Countries, or if on any day there are 

  
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at least two EMU Countries but no coin or currency is legal tender for the payment of public and private debts in all EMU Countries, then the Specified Currency for such payment shall be deemed
not to be available to the Company on such day. 
 Except as provided in the next paragraph, any payment to be made on this Security in a
Specified Currency other than U.S. dollars will be made in U.S. dollars if the Person entitled to receive such payment transmits a written request for such payment to be made in U.S. dollars to the Trustee at its Corporate Trust Office, Attention:
Global Corporate Trust, on or before the fifth Business Day before the payment is to be made. Such written request may be mailed, hand delivered, telecopied or delivered in any other manner approved by the Trustee. Any such request made with respect
to any payment on this Security payable to a particular Holder will remain in effect for all later payments on this Security payable to such Holder, unless such request is revoked on or before the fifth Business Day before a payment is to be made,
in which case such revocation shall be effective for such and all later payments. In the case of any payment of interest payable on an Interest Payment Date, such written request must be made by the Person who is the registered Holder of this
Security on the relevant Regular Record Date. 
 The U.S. dollar amount of any payment made pursuant to the immediately preceding paragraph
will be determined by the Exchange Rate Agent based upon the highest bid quotation received by the Exchange Rate Agent as of approximately 11:00 A.M., New York City time, on the second Business Day preceding the applicable payment date, from
three (or, if three are not available, then two) recognized foreign exchange dealers selected by the Exchange Rate Agent in The City of New York, in each case for the purchase by the quoting dealer, for U.S. dollars and for settlement on such
payment date of an amount of such Specified Currency for such payment equal to the aggregate amount of such Specified Currency payable on such payment date to all Holders of this Security who elect to receive U.S. dollar payments on such payment
date, and at which the applicable dealer commits to execute a contract. If the Exchange Rate Agent determines that two such bid quotations are not available on such second Business Day, such payment will be made in the Specified Currency for such
payment. All currency exchange costs associated with any payment in U.S. dollars on this Security will be borne by the Holder entitled to receive such payment, by deduction from such payment. 

Notwithstanding the foregoing, if any amount payable on this Security is payable on any day (including at Maturity) in a Specified Currency
other than U.S. dollars, and if such Specified Currency is not available to the Company on the two Business Days before such day, due to the imposition of exchange controls, disruption in a currency market or any other circumstances beyond the
control of the Company, the Company will be entitled to satisfy its obligation to pay such amount in such Specified Currency by making such payment in U.S. dollars. The amount of such payment in U.S. dollars shall be determined by the Exchange Rate
Agent on the basis of an exchange rate for such Specified Currency published at approximately 12:00 noon, New York City time, by a generally recognized and publicly available source, to be determined in the sole discretion of the Exchange Rate
Agent, on the latest day before the day on which such payment is to be made (the “Exchange Rate”). Any payment made under such circumstances in U.S. dollars where the required payment is in other than U.S. dollars will not
constitute an Event of Default under the Indenture or this Security. 

  
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 Manner of Payment — U.S. Dollars 

Except as provided in the next paragraph, payment of any amount payable on this Security in U.S. dollars will be made at the office or agency
of the Company maintained for that purpose in The City of New York (or at any other office or agency maintained by the Company for that purpose), in such coin or currency of the United States of America as at the time of payment is legal tender for
payment of public and private debts, against surrender (in the manner provided below) of this Security in the case of any payment due at the Maturity of the principal hereof (other than any payment of interest that first becomes due on an Interest
Payment Date); provided, however, that, at the option of the Company and subject to the next paragraph, payment of interest may be made by check mailed to the address of the Person entitled thereto as such address shall appear in the
Security Register. 
 Payment of any amount payable on this Security in U.S. dollars will be made by wire transfer of immediately available
funds to an account maintained by the payee with a bank located in the Borough of Manhattan, The City of New York, if (i) the principal of this Security is at least $1,000,000 (or the equivalent in another currency) and (ii) the Holder
entitled to receive such payment transmits a written request for such payment to be made in such manner to the Trustee at its Corporate Trust Office, Attention: Global Corporate Trust, on or before the fifth Business Day before the day on which such
payment is to be made; provided that, in the case of any such payment due at the Maturity of the principal hereof (other than any payment of interest that first becomes due on an Interest Payment Date), this Security must be surrendered (in
the manner provided below) at the office or agency of the Company maintained for that purpose in The City of New York (or at any other office or agency maintained by the Company for that purpose) in time for the Paying Agent to make such payment in
such funds in accordance with its normal procedures. Any such request made with respect to any payment on this Security payable to a particular Holder will remain in effect for all later payments on this Security payable to such Holder, unless such
request is revoked on or before the fifth Business Day before a payment is to be made, in which case such revocation shall be effective for such payment and all later payments. In the case of any payment of interest payable on an Interest Payment
Date, such written request must be made by the Person who is the registered Holder of this Security on the relevant Regular Record Date. The Company will pay any administrative costs imposed by banks in connection with making payments by wire
transfer with respect to this Security, but any tax, assessment or other governmental charge imposed upon any payment will be borne by the Holder of this Security and may be deducted from the payment by the Company or the Paying Agent. 

Manner of Payment — Other Specified Currencies 

Payment of any amount payable on this Security in a Specified Currency other than U.S. dollars will be made by wire transfer of immediately
available funds to such account as is maintained in such Specified Currency at a bank or other financial institution acceptable to the Company and the Trustee and as shall have been designated at least five Business Days prior to the applicable
payment date by the Person entitled to receive such payment; provided that, in the case of any such payment due at the Maturity of the principal hereof (other than any payment of 

  
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interest that first becomes due on an Interest Payment Date), this Security must be surrendered (in the manner provided below) at the office or agency of the Company maintained for that purpose
in The City of New York (or at any other office or agency maintained by the Company for that purpose) in time for the Paying Agent to make such payment in such funds in accordance with its normal procedures. Such account designation shall be made by
transmitting the appropriate information to the Trustee at its Corporate Trust Office in the Borough of Manhattan, The City of New York, by mail, hand delivery, telecopier or in any other manner approved by the Trustee. Unless revoked, any such
account designation made with respect to this Security by the Holder hereof will remain in effect with respect to any further payments with respect to this Security payable to such Holder. If a payment in a Specified Currency other than U.S. dollars
with respect to this Security cannot be made by wire transfer because the required account designation has not been received by the Trustee on or before the requisite date or for any other reason, the Company will cause a notice to be given to the
Holder of this Security at its registered address requesting an account designation pursuant to which such wire transfer can be made and such payment will be made within five Business Days after the Trustee’s receipt of such a designation
meeting the requirements specified above, with the same force and effect as if made on the due date. The Company will pay any administrative costs imposed by banks in connection with making payments by wire transfer with respect to this Security,
but any tax, assessment or other governmental charge imposed upon any payment will be borne by the Holder of this Security and may be deducted from the payment by the Company or the Paying Agent. 

Manner of Payment — Global Securities 

Notwithstanding any provision of this Security or the Indenture, if this Security is a Global Security, the Company may make any and all
payments of principal, premium and interest on this Security pursuant to the Applicable Procedures of the Depositary for this Security as permitted in the Indenture. 

Payments Due on a Business Day 

Notwithstanding any provision of this Security or the Indenture, if any amount of principal, premium or interest due at the Maturity hereof
would otherwise be due on this Security on a day (the “Specified Day”) that is not a Business Day, such amount may be paid or made available for payment on the Business Day that is next succeeding the Specified Day with the same
force and effect as if such amount were paid on the Specified Day, and no interest will accrue on the amount so payable for the period from the Specified Day to such next succeeding Business Day. 

As specified on the face of this Security, one of the following Business Day Conventions shall apply to any Interest Period or Interest
Payment Date other than one that falls on the date of Maturity of the principal hereof. If any such date would otherwise fall on a day that is not a Business Day: 

  
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 (i)    if the Business Day Convention specified on the
face hereof is “Following”, then such date shall be postponed to the next day that is a Business Day; 

(ii)    if the Business Day Convention specified on the face hereof is “Modified
Following”, then such date shall be postponed to the next day that is a Business Day; provided that if such next succeeding Business Day falls in the next calendar month, then such date shall be advanced to the immediately preceding
Business Day; 
 (iii)    if the Business Day Convention specified on the face hereof is
“Following Unadjusted”, any payment due on such date shall be postponed to the next day that is a Business Day; provided that interest due with respect to such Interest Payment Date shall not accrue from and including such
Interest Payment Date to and including the date of payment of such interest as so postponed; provided further that the Interest Periods shall not be adjusted for non-Business Days; and 

(iv)    if the Business Day Convention specified on the face hereof is “Modified Following
Unadjusted”, any payment due on such date shall be postponed to the next day that is a Business Day; provided that interest due with respect to such Interest Payment Date shall not accrue from and including such Interest Payment Date
to and including the date of payment of such interest as so postponed; and provided further that, if such day would fall in the next succeeding calendar month, the date of payment with respect to such Interest Payment Date shall be advanced
to the Business Day immediately preceding such Interest Payment Date; and provided further that the Interest Periods shall not be adjusted for non-Business Days. 

The provisions of the two immediately preceding paragraphs shall apply to this Security in lieu of the provisions of Section 1.13 of the
Indenture. 
 Reference is hereby made to the further provisions of this Security set forth on the reverse hereof, which further provisions
shall for all purposes have the same effect as if set forth at this place. 
 Unless the certificate of authentication hereon has been
executed by the Trustee by manual signature, this Security shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 

  
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 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed. 

Dated: 
  

					
	THE GOLDMAN SACHS GROUP, INC.


 
					
		
	 By:
	 	  

		 	Name:	 	
		 	Title:    	 	Attorney-in-Fact


 This is one of the Securities of the series designated herein and referred to in the Indenture. 

Dated: 
  

			
	THE BANK OF NEW YORK MELLON, 
as Trustee


 
			
		
	 By:
	 	  

		 	Authorized Signatory



  
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 (Reverse of Security) 

1.    Securities and Indenture 

This Security is one of a duly authorized issue of securities of the Company (herein called the “Securities”) issued and to be
issued in one or more series under a Senior Debt Indenture, dated as of July 16, 2008 (herein called the “Indenture”, which term shall have the meaning assigned to it in such instrument), between the Company and The Bank of New
York Mellon, as Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), and reference is hereby made to the Indenture for a statement of the respective rights, limitations of rights,
duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities and of the terms upon which the Securities are, and are to be, authenticated and delivered. 

2.    Series and Denominations 

This Security is one of the series of Securities designated on the face hereof, limited to an aggregate principal amount (or the equivalent
thereof in any other currency or currencies or currency units) as shall be determined and may be increased from time to time by the Company. References herein to “this series” mean the series of Securities designated as Medium Term
Notes, Series N, except that solely for purposes of Sections 9 and 10 below, the term “series” (and references to Securities of a series) shall be deemed to refer only to Securities having the same CUSIP number. 

This Security is issuable only in registered form without coupons in “Authorized Denominations”, which term shall have the
following meaning: for each Security having a principal amount payable in U.S. dollars, $1,000 or an integral multiple of $1,000 in excess thereof; for each Security having a principal amount payable in a Specified Currency other than U.S. dollars,
the amount of such Specified Currency equivalent, at the Exchange Rate on the first Business Day preceding the date on which the Company accepts the offer to purchase such Security, to $1,000 or an integral multiple of $1,000 in excess thereof. 

3.    Exchange Rate Agent and Related Terms 

If the principal of or interest on this Security is payable in a Specified Currency other than U.S. dollars, the Company has initially
appointed the institution named on the face of this Security as Exchange Rate Agent to act as such agent with respect to this Security, but the Company may, in its sole discretion, appoint any other institution (including any Affiliate of the
Company) to serve as any such agent from time to time. The Company will give the Trustee prompt written notice of any change in any such appointment. Insofar as this Security provides for any such agent to obtain rates, quotes or other data from a
bank, dealer or other institution for use in making any determination hereunder, such agent may do so from any institution or institutions of the kind contemplated hereby notwithstanding that any one or more of such institutions are such agent,
Affiliates of such agent or Affiliates of the Company. 

  
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 Any determination, decision or election that may be made by the Exchange Rate Agent pursuant
to the provisions set forth in this Security, including any determination with respect to a tenor, rate or adjustment or of the occurrence or non-occurrence of an event, circumstance or date and any decision
to take or refrain from taking any action or any selection will be conclusive and binding absent manifest error, may be made by such agent in its sole discretion, and, notwithstanding anything to the contrary in the documentation relating to this
Security, shall become effective without consent from the Holders of this Security or any other party. The Exchange Rate Agent shall not have any liability therefor. 

Unless otherwise specified on the face hereof, for all purposes of this Security, the term “Business Day” means each Monday,
Tuesday, Wednesday, Thursday or Friday that (i) is not a day on which banking institutions in The City of New York generally are authorized or obligated by law, regulation or executive order to close, (ii) if the Specified Currency for any
payment on this Security is other than U.S. dollars or euros, is not a day on which banking institutions in the principal financial center of the country issuing such Specified Currency generally are authorized or obligated by law, regulation or
executive order to close, (iii) if the Specified Currency for any payment on this Security is euros, is also a Euro Business Day and (iv) solely with respect to any payment or other action to be made or taken at any Place of Payment
outside The City of New York, is a Monday, Tuesday, Wednesday, Thursday or Friday that is not a day on which banking institutions in such Place of Payment generally are authorized or obligated by law, regulation or executive order to close.
“Euro Business Day” means each Monday, Tuesday, Wednesday, Thursday and Friday on which the Trans-European Automated Real-Time Gross Settlement Express Transfer (TARGET) System, or any successor system, is open for business. With
respect to any particular location, the close of business on any day on which business is not being conducted shall be deemed to mean 5:00 P.M., New York City time, on that day. 

References in this Security to U.S. dollars shall mean, as of any time, the coin or currency that is then legal tender for the payment of
public and private debts in the United States of America. 
 References in this Security to the euro shall mean, as of any time, the coin or
currency (if any) that is then legal tender for the payment of public and private debts in all EMU Countries. “EMU Countries” means, at any time, the countries (if any) then participating in the European Economic and Monetary Union
(or any successor union) pursuant to the Treaty on European Union of February 1992 (or any successor treaty), as it may be amended from time to time. 

References in this Security to a particular currency other than U.S. dollars and euros shall mean, as of any time, the coin or currency that
is then legal tender for the payment of public and private debts in the country issuing such currency on the Original Issue Date. 

4.    [IF APPLICABLE, INSERT — Additional Amounts. 

If the beneficial owner of this Security is a United States Alien (as defined below), the Company will pay all additional amounts that may be
necessary so that every net payment of the principal of and interest on this Security to such beneficial owner, after deduction or withholding 

  
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for or on account of any present or future tax, assessment or governmental charge imposed with respect to such payment by any U.S. Taxing Authority (as defined below), will not be less than the
amount provided for in this Security to be then due and payable; provided, however, that the Company shall have no obligation to pay additional amounts for or on account of any one or more of the following: 

(i)    any tax, assessment or other governmental charge imposed solely because at any time there is or was
a connection between such beneficial owner (or between a fiduciary, settlor, beneficiary, shareholder or member of such beneficial owner, if such beneficial owner is an estate, trust, partnership or corporation) and the United States (as defined
below) (other than the mere receipt of a payment on, or the ownership or holding of, this Security), including because such beneficial owner (or such fiduciary, settlor, beneficiary, shareholder or member) at any time, for U.S. federal income tax
purposes: (a) is or was a citizen or resident, or is or was treated as a resident, of the United States, (b) is or was present in the United States, (c) is or was engaged in a trade or business in the United States, (d) has or
had a permanent establishment in the United States, (e) is or was a personal holding company, a passive foreign investment company or a controlled foreign corporation, (f) is or was a corporation that accumulates earnings to avoid U.S.
federal income tax or (g) is or was a “10-percent shareholder” of the Company as defined in Section 871(h)(3) of the U.S. Internal Revenue Code or any successor provision; 

(ii)    any tax, assessment or governmental charge imposed solely because of a change in applicable law or
regulation, or in any official interpretation or application of applicable law or regulation, that becomes effective more than 15 days after the day on which the payment becomes due or is duly provided for, whichever occurs later; 

(iii)    any estate, inheritance, gift, sales, excise, transfer, wealth or personal property tax or any
similar tax, assessment or other governmental charge; 
 (iv)    any tax, assessment or other
governmental charge imposed solely because such beneficial owner or any other Person fails to comply with any certification, identification or other reporting requirement concerning the nationality, residence, identity or connection with the United
States of the Holder or any beneficial owner of this Security, if compliance is required by statute, by regulation of the U.S. Treasury Department or by an applicable income tax treaty to which the United States is a party, as a precondition to
exemption from such tax, assessment or other governmental charge; 
 (v)    any tax, assessment or other
governmental charge that can be paid other than by deduction or withholding from payments of principal of or interest on this Security; 

(vi)    any tax, assessment or other governmental charge imposed solely because the payment is to be made
by a particular Paying Agent (which term may include the Company) and would not be imposed if made by another Paying Agent (which term may include the Company); 

  
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 (vii)    any tax, assessment or other governmental
charge imposed solely because the Holder (1) is a bank purchasing this Security in the ordinary course of its lending business or (2) is a bank that is neither (A) buying this Security for investment purposes only nor (B) buying
this Security for resale to a third party that either is not a bank or holding this Security for investment purposes only; or 

(viii)    any combination of the taxes, assessments or other governmental charges described above. 

Additional amounts also will not be paid with respect to any payment of principal of or interest on this Security to any United States Alien
who is a fiduciary or a partnership, or who is not the sole beneficial owner of any such payment, to the extent that the Company would not be required to pay additional amounts to any beneficiary or settlor of such fiduciary or any member of such a
partnership, or to any beneficial owner of the payment, if that Person had been treated as the beneficial owner of this Security for these purposes. 

In addition, any amounts to be paid on this Security will be paid net of any deduction or withholding imposed or required pursuant to Sections
1471 through 1474 of the U.S. Internal Revenue Code (the “Code”), any current or future regulations or official interpretations thereof, any agreement entered into pursuant to Section 1471(b) of the Code, or any fiscal or
regulatory legislation, rules or practices adopted pursuant to any intergovernmental agreement entered into in connection with the implementation of such Sections of the Code, and no additional amounts will be required to be paid on account of any
such deduction or withholding. 
 The term “United States Alien” means any Person who, for U.S. federal income tax
purposes, is a nonresident alien individual, a foreign corporation, a foreign partnership one or more of the members of which is, for United States federal income tax purposes, a foreign corporation, a nonresident alien individual or a nonresident
alien fiduciary of a foreign estate or trust, or a nonresident alien fiduciary of an estate or trust that is not subject to U.S. federal income tax on a net income basis on income or gain from this Security. For the purposes of this Section 4
and Section 5 only, (a) the term “United States” means the United States of America (including the states thereof and the District of Columbia), together with the territories, possessions and all other areas subject to the
jurisdiction of the United States of America and (b) the term “U.S. Taxing Authority” means the United States of America or any state, other jurisdiction or taxing authority in the United States. 

Except as specifically provided in this Security, the Company shall not be required to make any payment with respect to any tax, assessment or
other governmental charge imposed by any government or any political subdivision or taxing authority thereof or therein. 
 Whenever in the
Securities of this series (or in the Indenture, including in Sections 5.01(1) and (2) thereof, insofar as applicable to this series) there is a reference, in any context, to the payment of the principal of or interest on any Security of this
series, such mention shall be deemed to include mention of any payment of additional amounts to United States Aliens in respect of such payment of principal or interest to the extent that, in such context, such additional


  
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amounts are, were or would be payable in respect thereof pursuant to this Section 4 or any corresponding section of another Security of this series, as the case may be. Express mention of
the payment of additional amounts in any provision of any Security of this series shall not be construed as excluding additional amounts in the provisions of any Security of this series (or of the Indenture insofar as it applies to this series)
where such express mention is not made.] 
 5.    Redemption at the
Company’s Option 
 (a)    [IF APPLICABLE, INSERT
— This Security may be redeemed, as a whole but not in part, at the option of the Company, at a redemption price equal to 100% of the principal amount to be redeemed, together with interest accrued and unpaid to but excluding the
Redemption Date, if, as a result of any amendment to, or change in, the laws or regulations of any U.S. Taxing Authority (as defined in Section 4 above), or any amendment to or change in any official interpretation or application of such laws
or regulations, which amendment or change becomes effective or is announced on or after [INSERT TRADE DATE], the Company will become obligated to pay, on the next Interest Payment Date, additional amounts in respect of this Security
pursuant to Section 4 of this Security. If the Company becomes entitled to redeem this Security, it may do so on any day thereafter pursuant to the Indenture; provided, however, that (1) the Company gives the Holder of this
Security notice of such redemption not more than 60 days nor less than 30 days prior to the Redemption Date as provided in the Indenture, (2) no such notice of redemption may be given earlier than 90 days prior to the next Interest Payment
Date on which the Company would be obligated to pay such additional amounts and (3) at the time such notice is given, such obligation to pay such additional amounts remains in effect. Immediately prior to the giving of any notice of redemption
of Securities pursuant to this Section 5(a), the Company will deliver to the Trustee an Officers’ Certificate stating that the Company is entitled to effect such redemption and setting forth in reasonable detail a statement of facts
showing that the conditions precedent to the right of the Company to so redeem the Securities have occurred. Interest installments due on or prior to a Redemption Date will be payable to the Holder of this Security or one or more Predecessor
Securities, of record at the close of business on the relevant record date, all as provided in the Indenture.] 

(b)    [IF APPLICABLE, INSERT — In addition, if a Redemption Commencement Date or the occurrence
of a specified event giving rise to redemption is specified on the face hereof, this Security shall be redeemable at the option of the Company before the Maturity of the principal thereof. If a Redemption Commencement Date or a redemption event is
so specified, and unless otherwise specified on the face hereof, this Security is subject to redemption upon the notice specified on the face hereof, or if no notice period is specified, upon not less than 15 days’ nor more than 60 days’
notice, at any time and from time to time on or after the Redemption Commencement Date, in each case as a whole or in part, at the election of the Company and at the applicable Redemption Price specified on the face hereof (expressed as a percentage
of the principal amount of this Security to be redeemed), together with accrued and unpaid interest to but excluding the Redemption Date, but interest installments due on or prior to such Redemption Date will be payable to the Holder of this
Security, or one or more Predecessor Securities, of record on the relevant record dates referred to on the face hereof, all as provided in the Indenture.] 

  
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 (c)    [IF APPLICABLE, INSERT – In addition,
this Security shall be redeemable at the option of the Company before the Maturity of the principal thereof, in whole at any time or in part from time to time, on or after
                     (or, if any additional Securities are issued after the Original Issue Date, beginning six months after the last issue date for
the additional Securities), except for                     , at a redemption price equal to the greater of (1) 100% of the principal amount to be
redeemed or (2) as determined by the Quotation Agent described below, the sum of the present values of the remaining scheduled payments of principal and interest, to the [and
including                (assuming for this purpose that the Securities of this series would mature
on                , rather than the Stated Maturity Date of the principal hereof)][Stated Maturity Date], on the Securities to be redeemed, not including any portion of
these payments of interest accrued as of the date on which the Securities are to be redeemed, discounted to the date on which the Securities are to be redeemed on a [semi-annual] basis, applying the [Insert Day Count Convention], at the
Treasury Rate (as defined below) plus          basis points, plus, in each case, interest accrued to the Redemption Date. Notice of a redemption pursuant to this Section [5(c)] must be provided to the Holder
of this Security not more than 60 days nor less than 15 days prior to the Redemption Date. Interest installments due on or prior to a Redemption Date will be payable to the Holder of this Security or one or more Predecessor Securities, of record at
the close of business on the relevant record date, all as provided in the Indenture. 
 “Treasury Rate” means: 

 

	 	•	 	 the average of the yields for the five Business Days prior to the date of calculation, appearing in the most
recently published statistical release appearing on the website of the Board of Governors of the Federal Reserve System or in another recognized electronic source, in each case as determined by the Quotation Agent in its sole discretion, and which
establishes yields on actively traded U.S. Treasury securities adjusted to constant maturity, for the maturity most closely corresponding to the remaining term of the Securities to be redeemed, [(assuming for this purpose that the Securities of this
series would mature on                , rather than the Stated Maturity Date of the principal hereof)] or if no maturity is within three months before or after this time
period, yields for the two published maturities most closely corresponding to this time period will be determined and the Treasury Rate will be interpolated or extrapolated from those yields on a straight-line basis, rounding to the nearest month;
or 


  

	 	•	 	 if the release or any successor release is not published during the five Business Days preceding the calculation
date or does not contain such yields, the annual rate equal to the semi-annual equivalent yield to maturity of the Comparable Treasury Issue (as defined below), calculated using a price for the Comparable Treasury Issue, expressed as a percentage of
its principal amount, equal to the Comparable Treasury Price (as defined below) for the Redemption Date. 


 The Treasury
Rate will be calculated on the third Business Day preceding the Redemption Date. 

  
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 “Quotation Agent” shall initially mean Goldman Sachs & Co. LLC or its
successor. However, if Goldman Sachs & Co. LLC ceases to be a primary U.S. Government securities dealer in New York City, the Company will appoint another primary U.S. Government securities dealer to serve as the Quotation Agent. 

“Comparable Treasury Issue” means, with respect to any Redemption Date, the United States Treasury security selected by the
Quotation Agent as being the most recently issued United States Treasury note or bond as displayed by Bloomberg L.P. (or any successor service) on screens PX1 through PX8 (or any other screens as may replace such screens on such service) that has a
remaining term comparable to the remaining term of the Securities to be redeemed [(assuming for this purpose that the Securities of this series would mature
on                , rather than the Stated Maturity Date of the principal hereof)]. 

“Comparable Treasury Price” means, with respect to any Redemption Date, (1) the average of five Reference Treasury Dealer
Quotations (as defined below) for such Redemption Date, after excluding the highest and lowest of such Reference Treasury Dealer Quotations, or (2) if the Quotation Agent obtains fewer than five such Reference Treasury Dealer Quotations, the
average of all such quotations. 
 “Reference Treasury Dealer Quotations” means, with respect to each Reference Treasury Dealer
(as defined below) and any Redemption Date, the average, as determined by the Quotation Agent, of the bid and ask prices for the Comparable Treasury Issue, expressed in each case as a percentage of its principal amount, quoted in writing to the
Quotation Agent by such Reference Treasury Dealer at 5:00 p.m., New York City time, on the third Business Day preceding such Redemption Date. 

“Reference Treasury Dealer” means (1) the Quotation Agent or (2) any other primary U.S. Government securities dealer
selected by the Quotation Agent after consultation with the Company.] 
 6.    Repayment at the
Holder’s Option 
 Except as otherwise may be provided on the face hereof, if one or more Repayment Dates are specified
on the face hereof, this Security will be repayable in whole or in part in an amount equal to any Authorized Denomination (provided that the remaining principal amount of any Security surrendered for partial repayment shall at least equal an
Authorized Denomination), on any such Repayment Date, in each case at the option of the Holder and at the applicable Repayment Price specified on the face hereof (expressed as a percentage of the principal amount to be repaid), together with accrued
interest to the applicable Repayment Date (but interest installments due on or prior to such Repayment Date will be payable to the Holder of this Security, or one or more Predecessor Securities, of record at the close of business on the relevant
Regular Record Date as provided in the Indenture). If this Security provides for more than one Repayment Date and the Holder exercises its option to elect repayment, the Holder shall be deemed to have elected repayment on the earliest Repayment Date
after all conditions to such exercise have been satisfied, and references herein to the “applicable Repayment Date” shall mean such earliest Repayment Date. 

  
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 In order for the exercise of such option to be effective and this Security to be repaid, the
Company must receive at the applicable address of the Trustee set forth below (or at such other place or places of which the Company shall from time to time notify the Holder of this Security), on any Business Day not later than the 15th, and not
earlier than the 25th, calendar day prior to the applicable Repayment Date (or, if either such calendar day is not a Business Day, the next succeeding Business Day), either (i) this Security, with the form below entitled “Option to Elect
Repayment” duly completed and signed, or (ii) a facsimile transmission or letter from a member of a national securities exchange or the Financial Industry Regulatory Authority, Inc., a commercial bank or a trust company in the United
States of America setting forth (a) the name, address and telephone number of the Holder of this Security, (b) the principal amount of this Security and the amount of this Security to be repaid, (c) a statement that the option to
elect repayment is being exercised thereby and (d) a guarantee stating that the Company will receive this Security, with the form below entitled “Option to Elect Repayment” duly completed and signed, not later than five Business Days
after the date of such facsimile transmission or letter (provided that this Security and form duly completed and signed are received by the Company by such fifth Business Day). Any such election shall be irrevocable. The address to which such
deliveries are to be made is The Bank of New York Mellon, Attention: Global Corporate Trust, 240 Greenwich Street, 7E, New York, New York 10286 (or at such other places as the Company or the Trustee shall notify the Holder of this Security). All
questions as to the validity, eligibility (including time of receipt) and acceptance of any Security for repayment will be determined by the Company, whose determination will be final and binding. Notwithstanding the foregoing, (x) if this
Security is a Global Security, the option of the Holder to elect repayment may be exercised in accordance with the Applicable Procedures of the Depositary for this Security at least 15 calendar days prior to the applicable Repayment Date and
(y) whether or not this Security is a Global Security, the option of the Holder to elect repayment may be exercised in any such manner as the Company may approve. 

7.    Transfer and Exchange 

As provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Security is registrable in the Security
Register, upon surrender of this Security for registration of transfer at the office or agency of the Company in any place where the principal of and any premium and interest on this Security are payable, duly endorsed by, or accompanied by a
written instrument of transfer in form satisfactory to the Company and the Security Registrar duly executed by, the Holder hereof or his or her attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like
tenor, of Authorized Denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 

As provided in the Indenture and subject to certain limitations therein set forth, Securities of this series are exchangeable for a like
aggregate principal amount of Securities of this series and of like tenor of a different Authorized Denomination, as requested by the Holder surrendering the same. 

  
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 No service charge shall be made for any such registration of transfer or exchange, but the
Company may require payment of a sum sufficient to cover any tax or other governmental charge payable in connection therewith. 
 Prior to
due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not
this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 
 If this
Security is a Global Security, this Security shall be subject to the provisions of the Indenture relating to Global Securities, including the limitations in Section 3.05 thereof on transfers and exchanges of Global Securities. 

8.    Defeasance 

The Indenture contains provisions for Defeasance at any time of the entire indebtedness of this Security or certain restrictive covenants,
Events of Default and Covenant Breaches with respect to this Security, in each case upon compliance with certain conditions set forth in the Indenture. Unless otherwise specified on the face hereof, both of such provisions are applicable to this
Security. 
 9.    Remedies 

If an Event of Default with respect to Securities of a series shall occur and be continuing, the principal of the Securities of such series may
be declared due and payable in the manner and with the effect provided in the Indenture. With respect to the Securities of a series, the only Events of Default are payment defaults on the Securities of such series that continue for 30 days and
insolvency events, all as specified in the Indenture. Any other default under or breach of the Indenture or the Securities will not give rise to an Event of Default, whether after notice, the passage of time or otherwise. 

As provided in and subject to the provisions of the Indenture, the Holder of a Security of any series shall not have the right to institute
any proceeding with respect to the Indenture or for the appointment of a receiver or trustee or for any other remedy thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default or Covenant
Breach with respect to the Securities of such series, the Holders of not less than 25% in principal amount of the Securities of such series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of
such Event of Default or Covenant Breach, as applicable, as Trustee and offered the Trustee indemnity reasonably satisfactory to it, and the Trustee shall not have received from the Holders of a majority in principal amount of the Securities of such
series at the time Outstanding a direction inconsistent with such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request 

  
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and offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the enforcement of any payment of principal hereof or any premium or interest
hereon on or after the respective due dates expressed herein. 
 If so provided pursuant to the terms of any specific Securities, the
above-referenced provisions of the Indenture regarding the ability of Holders to waive certain defaults, or to request the Trustee to institute proceedings (or to give the Trustee other directions) in respect thereof, may be applied differently with
regard to such Securities. 
 No reference herein to the Indenture and no provision of this Security or of the Indenture shall alter or
impair the obligation of the Company, which is absolute and unconditional, to pay the principal of (and premium, if any) and interest on this Security at the times, place and rate, and in the coin or currency, herein prescribed. 

As used in this Section 9, the term “series” (and references to the Securities of a series) shall mean only Securities having
the same CUSIP number. 
 10.    Modification and Waiver 

The Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification of the rights and obligations of
the Company and the rights of the Holders of the Securities to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a majority in principal amount of all Securities at the time Outstanding to
be affected, considered together as one class for this purpose (such Securities to be affected may be Securities of the same or different series and, with respect to any series, may comprise fewer than all the Securities of such series). The
Indenture also contains provisions (i) permitting the Holders of a majority in principal amount of the Securities at the time Outstanding to be affected under the Indenture, considered together as one class for this purpose (such affected
Securities may be Securities of the same or different series and, with respect to any particular series, may comprise fewer than all the Securities of such series), on behalf of the Holders of all Securities so affected, to waive compliance by the
Company with certain provisions of the Indenture and (ii) permitting the Holders of a majority in principal amount of the Securities at the time Outstanding of any series to be affected under the Indenture (with each such series considered
separately for this purpose), on behalf of the Holders of all Securities of such series, to waive certain past defaults under the Indenture and their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and
binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this
Security. For the purpose of this paragraph, the term “default” means, with respect to any Securities, any event which is, or after notice or lapse of time or both would become, an Event of Default or Covenant Breach in respect of such
Securities. As used in this Section 10, the term “series” (and references to the Securities of a series) shall mean only Securities having the same CUSIP number. 

  
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 11.    Governing Law 

This Security and the Indenture shall be governed by and construed in accordance with the laws of the State of New York. 

  
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 CUSIP NO. 

ORIGINAL ISSUE DATE: 

THE GOLDMAN SACHS GROUP, INC. 

MEDIUM-TERM NOTE, SERIES N 

OPTION TO ELECT REPAYMENT 

TO BE COMPLETED ONLY IF THIS SECURITY IS REPAYABLE 

AT THE OPTION OF THE HOLDER AND THE HOLDER 

ELECTS TO EXERCISE SUCH RIGHT 

The undersigned hereby irrevocably requests and instructs the Company to repay the Security referred to in this notice (or the portion thereof
specified below) at the applicable Repayment Price, together with interest to the Repayment Date, all as provided for in such Security, to the undersigned, whose name, address and telephone number are as follows: 

(please print name of the undersigned) 
 (please print address
of the undersigned) 
 (please print telephone number of the undersigned) 

If such Security provides for more than one Repayment Date, the undersigned requests repayment on the earliest Repayment Date after the
requirements for exercising this option have been satisfied, and references in this notice to the Repayment Date mean such earliest Repayment Date. Terms used in this notice that are defined in such Security are used herein as defined therein. 

For such Security to be repaid the Company must receive at the applicable address of the Trustee set forth below or at such other place or
places of which the Company or the Trustee shall from time to time notify the Holder of such Security, any Business Day not later than the 15th or earlier than the 25th calendar day prior to the Repayment Date (or, if either such calendar day is not
a Business Day, the next succeeding Business Day), (i) such Security, with this “Option to Elect Repayment” form duly completed and signed, or (ii) a facsimile transmission or letter from a member of a national securities exchange or
the Financial Industry Regulatory Authority, Inc., a commercial bank or a trust company in the United States of America setting forth (a) the name, address and telephone number of the Holder of such Security, (b) the principal amount of
such Security and the amount of such Security to be repaid, (c) a statement that the option to elect repayment is being exercised thereby and (d) a guarantee stating that such Security to be repaid with the form entitled “Option to
Elect Repayment” on the addendum to the Security duly completed and signed will be received by the Company not later than five Business Days after the date of such facsimile transmission or letter (provided that such Security and form
duly completed and signed are received by the Company by such fifth Business Day). The address to which such deliveries are to be made is: 

  
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 The Bank of New York Mellon 

Attention: Global Corporate Trust 
 240 Greenwich Street, 7E 

New York, New York 10286 
 or at such other place as the Company
or the Trustee shall notify the Holder of such Security. 
 If less than the entire principal amount of such Security is to be repaid,
specify the portion thereof (which shall equal any Authorized Denomination) that the Holder elects to have repaid: 
  

 
 and specify the denomination or denominations (which
shall equal any Authorized Denomination) of the Security or Securities to be issued to the Holder in respect of the portion of such Security not being repaid (in the absence of any specification, one Security will be issued in respect of the portion
not being repaid): 
  
  

 

			
	Date:                         	  	  
 Notice: The signature to this Option to Elect
Repayment must correspond with the name of the Holder as written on the face of such Security in every particular without alteration or enlargement or any other change whatsoever.



  
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 ABBREVIATIONS 

The following abbreviations, when used in the inscription on the face of this Security, 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 the right of survivorship and not as tenants in common 
  

							
	 UNIF GIFT MIN
  
	  	 Custodian
  
	  	  

	ACT –	  	
                    

(Cust)
	  	
                    

        (Minor)        
	  	  



					
	  
 under Uniform Gifts to Minors Act

 
 (State)

 

	 Additional abbreviations may also be used though not in the above list.

 



  
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 ASSIGNMENT 

FOR VALUE RECEIVED, the undersigned hereby sell(s), assign(s) and transfer(s) unto 

 
  

 
 PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING
NUMBER OF ASSIGNEE 
  

							
	     

 
  
	  		  		  	

  
  

 
  

(Please Print or Typewrite Name and Address Including Postal Zip Code of Assignee) 

 
  

the attached Security and all rights thereunder, and hereby irrevocably constitutes and appoints 

 
  

 
 to transfer said Security on the books of the Company,
with full power of substitution in the premises. 
  

					
	 Date:
                        
  

Signature Guaranteed
  

NOTICE: Signature must be guaranteed.
	 	        	  	  
 NOTICE: The signature to this assignment must
correspond with the name of the Holder as written upon the face of the attached Security in every particular, without alteration or enlargement or any change whatever.



  
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