Document:

Form of Warrant to purchase shares of Series B

 Exhibit 10.3 
  
 NEITHER THIS SECURITY NOR THE SECURITIES INTO WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE
COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT
TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES
LAWS AS EVIDENCED BY A LEGAL OPINION OF COUNSEL TO THE TRANSFEROR TO SUCH EFFECT, THE SUBSTANCE OF WHICH SHALL BE REASONABLY ACCEPTABLE TO THE COMPANY. THIS SECURITY AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS SECURITY MAY BE PLEDGED IN
CONNECTION WITH A BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES. 
  
 SERIES B CONVERTIBLE PREFERRED STOCK WARRANT 
  
 To Purchase              Shares of Series B Convertible Preferred Stock 
  
 Cambridge Heart, Inc. 
  
 THIS WARRANT (the “Warrant”) certifies that, for value received,
                     (the “Holder”), is entitled, upon the terms and subject to the limitations on exercise and the
conditions hereinafter set forth, at any time on or after the date hereof (the “Initial Exercise Date”) and on or prior to 5:00 p.m. (New York City time) on December 6, 2009 (the “Termination Date”) but not
thereafter, to subscribe for and purchase from Cambridge Heart, Inc., a Delaware corporation (the “Company”), up to              shares of Preferred Stock (the
“Warrant Preferred Stock”) at a purchase price of $1,100 per share (the “Warrant Exercise Price”) or Common Stock of the Company, in certain circumstances as described herein. The initial conversion price of the
Warrant Preferred Stock shall be equal to $0.45, subject to adjustment hereunder (“Warrant Conversion Price”). The Warrant Preferred Stock shall be in the form of the Preferred Stock (with the same rights, privileges and preferences
set forth in the Transaction Documents, including without limitation, the Certificate of Designation) issued pursuant to the Purchase Agreement, mutatis mutandis. 
  
 Section 1. Definitions. Capitalized terms used and not otherwise defined herein shall have the meanings set
forth in that certain Securities Purchase Agreement (the “Purchase Agreement”), dated as of December 6, 2004, among the Company and the purchasers signatory thereto. 
  

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 Section 2. Exercise. 
  
 a) Exercise of Warrant. Exercise of the purchase rights represented by this Warrant may be made at
any time or times on or after the Initial Exercise Date and on or before the Termination Date by delivery to the Company of a duly executed facsimile copy of the Notice of Exercise Form annexed hereto (or such other office or agency of the Company
as it may designate by notice in writing to the registered Holder at the address of such Holder appearing on the books of the Company) and the payment of the Warrant Exercise Price therefor by wire transfer or cashier’s check drawn on a United
States bank. Upon exercise of the Warrant, the Company shall issue shares of Warrant Preferred Stock with a per share Stated Value (as defined in the Certificate of Designation) of $1000. 
  
 b) Cashless Exercise. If at any time after one (1)
year from the date of issuance of this Warrant there is no effective Registration Statement registering the resale of the Warrant Shares underlying the Warrant Preferred Stock issuable hereunder, then this Warrant may also be exercised at such time
for shares of Common Stock by means of a “cashless exercise” in which the Holder shall be entitled to receive a certificate for the number of Common Stock equal to the quotient obtained by dividing [(A-B) (X)] by (A), where: 
  

			
	 (A) =
	 	the average VWAP for the five Trading Days immediately preceding the date of such election;
		
	 (B)  =
	 	the Warrant Conversion Price, as adjusted; and
		
	 (X)  =
	 	the number of Warrant Shares issuable upon conversion of the Warrant Preferred Stock issuable hereunder in accordance with the terms of this Warrant by means of a cash exercise of this
Warrant followed by an immediate conversion of such Warrant Preferred Stock issuable thereupon rather than a cashless exercise.

  
 Notwithstanding
anything herein to the contrary, on the Termination Date, this Warrant shall be automatically exercised via cashless exercise pursuant to this Section 2(b). 
  
 c) Mechanics of Exercise. 
  
 i. Authorization of Warrant Preferred Stock. The Company covenants that during the period the Warrant is outstanding, it will
reserve from its authorized and unissued Common Stock a sufficient number of shares to provide for the issuance of all of the shares of Common Stock underlying the Warrant Preferred Stock (the “Warrant Conversion Shares”). The
Company further covenants that its issuance of this Warrant shall constitute full authority to its officers who are charged with the duty of executing certificates to execute and issue the necessary certificates for the Warrant Preferred Stock upon
the exercise of the purchase rights under this Warrant and certificates upon conversion and exercise of the Warrant 
  

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 Preferred Stock. The Company covenants that the Warrant Preferred Stock which may be issued upon the
exercise of the purchase rights represented by this Warrant and the Warrant Conversion Shares issuable thereunder will, upon exercise of the purchase rights represented by this Warrant, be duly authorized, validly issued, fully paid and
nonassessable and free from all taxes, liens and charges in respect of the issue thereof (other than taxes in respect of any transfer occurring contemporaneously with such issue). The Company will take all such reasonable action as may be necessary
to assure that the Warrant Preferred Stock and Warrant Conversion Shares may be issued as provided herein without violation of any applicable law or regulation, or of any requirements of the Trading Market upon which the Common Stock may be listed.

  
 ii. Delivery of Certificates Upon
Exercise. Certificates for the Warrant Preferred Stock purchased hereunder shall be delivered to the Holder within three (3) Trading Days from the delivery to the Company of the Notice of Exercise Form, surrender of this Warrant and payment of
the Warrant Exercise Price as set forth above (“Warrant Security Delivery Date”). This Warrant shall be deemed to have been exercised on the date the payment of the principal amount is received by the Company. The Warrant Preferred
Stock shall be deemed to have been issued, and Holder or any other person so designated to be named therein shall be deemed to have become a holder of record of such security for all purposes, as of the date the Warrant has been exercised by payment
to the Company of the principal amount and all taxes required to be paid by the Holder, if any, pursuant to Section 2(e)(vii) prior to the issuance of such security, have been paid. 
  
 iii. Delivery of New Warrants Upon Exercise. If this Warrant shall have been exercised in part, the
Company shall, at the time of delivery of the certificate or certificates representing the Warrant Preferred Stock, deliver to Holder a new Warrant evidencing the rights of Holder to purchase the unpurchased Warrant Preferred Stock called for by
this Warrant, which new Warrant shall in all other respects be identical with this Warrant. 
  
 iv. Rescission Rights. If the Company fails to deliver to the Holder a certificate or certificates representing the Warrant
Preferred Stock pursuant to this Section 2(e)(iv) by the Warrant Security Delivery Date, then the Holder will have the right to rescind such exercise. 
  
 v. Charges, Taxes and Expenses. Issuance of certificates for Warrant Preferred Stock shall be made without charge to the Holder for
any issue or transfer tax or other incidental expense in respect of the issuance of such certificate, all of which taxes and expenses shall be paid by the Company, and such certificates shall be issued in the name of the Holder or in such name or
names as may be directed by the Holder; 
  

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 provided, however, that in the event certificates for Warrant Preferred Stock are to be
issued in a name other than the name of the Holder, this Warrant when surrendered for exercise shall be accompanied by the Assignment Form attached hereto duly executed by the Holder; and the Company may require, as a condition thereto, the payment
of a sum sufficient to reimburse it for any transfer tax incidental thereto. 
  
 vi. Closing of Books. The Company will not close its records in any manner which prevents the timely exercise of this Warrant, pursuant to the terms hereof or the conversion of the Warrant Preferred Stock
pursuant to the terms hereof. 
  
 d) Call
Provision. Subject to the provisions of this Section 2(d), if after the Effective Date the Closing Price for each of twenty (20) consecutive Trading Days (the “Measurement Period”, which period shall not have commenced until
after the Effective Date) exceeds $1.35, subject to adjustment for reverse and forward stock splits, stock dividends, stock combinations and other similar transactions of the Common Stock (the “Threshold Price”), then the Company
may, within one Trading Day of the end of such period, call for cancellation of all or any portion of this Warrant for which a Notice of Exercise has not yet been delivered (such right, a “Call”). To exercise this right, the Company
must deliver to the Holder an irrevocable written notice (a “Call Notice”), indicating therein the portion of unexercised portion of this Warrant to which such notice applies. If the conditions set forth below for such Call are
satisfied from the period from the date of the Call Notice through and including the Call Date (as defined below), then any portion of this Warrant subject to such Call Notice for which a Notice of Exercise shall not have been received by the Call
Date will be cancelled at 6:30 p.m. (New York City time) on the 30th Trading Day after the date the Call Notice is
received by the Holder (such date, the “Call Date”). Any unexercised portion of this Warrant to which the Call Notice does not pertain will be unaffected by such Call Notice. In furtherance thereof, the Company covenants and agrees
that it will honor all Notices of Exercise with respect to Warrant Preferred Stock subject to a Call Notice that are tendered through 6:30 p.m. (New York City time) on the Call Date. The parties agree that any Notice of Exercise delivered following
a Call Notice shall first reduce to zero the number of Warrant Preferred Stock subject to such Call Notice prior to reducing the remaining Warrant Preferred Stock available for purchase under this Warrant. For example, if (x) this Warrant then
permits the Holder to acquire $1,000 Stated Value of Warrant Preferred Stock, (y) a Call Notice pertains to $750 Stated Value of Warrant Preferred Stock, and (z) prior to 6:30 p.m. (New York City time) on the Call Date the Holder tenders a Notice of
Exercise in respect of $500 Stated Value of Warrant Preferred Stock, then (1) on the Call Date the right under this Warrant to acquire $250 Stated Value of Warrant Preferred Stock will be automatically cancelled, (2) the Company, in the time and
manner required under this Warrant, will have issued and delivered to the Holder $500 Stated Value of Warrant Preferred Stock in respect of the exercises following receipt of the Call Notice, and (3) the Holder may, until the Termination Date,
exercise this Warrant for $250 Stated Value of Warrant Preferred Stock (subject to adjustment as herein provided and subject to subsequent Call Notices). Subject again to the provisions of this Section 2(d), the Company may deliver subsequent Call
Notices for any portion of this Warrant for which 
  

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 the Holder shall not have delivered a Notice of Exercise. Notwithstanding anything to the contrary set
forth in this Warrant, the Company may not deliver a Call Notice or require the cancellation of this Warrant (and any Call Notice will be void), unless, from the beginning of the 20th consecutive Trading Days used to determine whether the Common Stock has achieved the Threshold Price through the Call Date, (i) the Company shall have honored
in accordance with the terms of this Warrant and the Warrant Preferred Stock issuable hereunder all Notices of Exercise delivered by 6:30 p.m. (New York City time) on the Call Date, (ii) the Registration Statement shall be effective as to all
Warrant Conversion Shares and the prospectus thereunder available for use by the Holder for the resale of all such Warrant Conversion Shares and (iii) the Common Stock shall be listed or quoted for trading on the Trading Market. The Company’s
right to Call the Warrant shall be exercised ratably among the Holders based on each Holder’s initial purchase of Common Stock pursuant to the Purchase Agreement. 
  
 Section 3. Certain Adjustments. 
  
 a) Stock Dividends and Splits. If the Company, at any time while this Warrant is outstanding: (A)
pays a stock dividend or otherwise make a distribution or distributions on shares of its Common Stock or any other equity or equity equivalent securities payable in shares of Common Stock (which, for avoidance of doubt, shall not include any shares
of Common Stock issued by the Company pursuant to the Warrant Preferred Stock), (B) subdivides outstanding shares of Common Stock into a larger number of shares, (C) combines (including by way of reverse stock split) outstanding shares of Common
Stock into a smaller number of shares, or (D) issues by reclassification of shares of the Common Stock any shares of capital stock of the Company, then in each case the Warrant Conversion Price shall be multiplied by a fraction of which the
numerator shall be the number of shares of Common Stock (excluding treasury shares, if any) outstanding before such event and of which the denominator shall be the number of shares of Common Stock outstanding after such event. Any adjustment made
pursuant to this Section 3(a) shall become effective immediately after the record date for the determination of stockholders entitled to receive such dividend or distribution and shall become effective immediately after the effective date in the
case of a subdivision, combination or re-classification. 
  
 b) Subsequent Equity Sales. If the Company or any Subsidiary thereof, as applicable, at any time while this Warrant is outstanding, shall offer, sell, grant any option to purchase or offer, sell or grant any
right to reprice its securities, or otherwise dispose of or issue (or announce any offer, sale, grant or any option to purchase or other disposition) any Common Stock or Common Stock Equivalents entitling any Person to acquire shares of Common
Stock, at an effective price per share less than the then Warrant Conversion Price (such lower price, the “Base Share Price” and such issuances collectively, a “Dilutive Issuance”), as adjusted hereunder (if the
holder of the Common Stock or Common Stock Equivalents so issued shall at any time, whether by operation of purchase price adjustments, reset provisions, floating conversion, exercise or exchange prices or otherwise, or due to warrants, options or
rights per share which is issued in connection with such issuance, be entitled to receive shares of Common Stock at an effective price per share which is less than the Warrant Conversion Price, such issuance 
  

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 shall be deemed to have occurred for less than the Warrant Conversion Price), then, the Warrant
Conversion Price shall be reduced to a price equal to 110% of the Base Share Price. Such adjustment shall be made whenever such Common Stock or Common Stock Equivalents are issued. The Company shall notify the Holder in writing, no later than the
Trading Day following the issuance of any Common Stock or Common Stock Equivalents subject to this section, indicating therein the applicable issuance price, or of applicable reset price, exchange price, conversion price and other pricing terms
(such notice the “Dilutive Issuance Notice”). For purposes of clarification, whether or not the Company provides a Dilutive Issuance Notice pursuant to this Section 3(b), upon the occurrence of any Dilutive Issuance, after the date
of such Dilutive Issuance the Holder is entitled to receive a number of securities based upon the Base Share Price regardless of whether the Holder accurately refers to the Base Share Price in the Notice of Exercise. 
  
 c) Pro Rata Distributions. If the Company, at any
time while this Warrant is outstanding, distributes to all holders of Common Stock (and not to Holders) evidences of its indebtedness or assets or rights or warrants to subscribe for or purchase any security other than the Common Stock (which shall
be subject to Section 3(b), then in each such case the Warrant Conversion Price shall be determined by multiplying such Warrant Conversion Price in effect immediately prior to the record date fixed for determination of stockholders entitled to
receive such distribution by a fraction of which the denominator shall be the Closing Price determined as of the record date mentioned above, and of which the numerator shall be such Closing Price on such record date less the then fair market value
at such record date of the portion of such assets or evidence of indebtedness so distributed applicable to one outstanding share of the Common Stock as determined by the Board of Directors in good faith. In either case the adjustments shall be
described in a statement provided to the Holder of the portion of assets or evidences of indebtedness so distributed or such subscription rights applicable to one share of Common Stock. Such adjustment shall be made whenever any such distribution is
made and shall become effective immediately after the record date mentioned above. 
  
 d) Calculations. All calculations and adjustments to the Warrant Conversion Price under this Section 3 shall be made to the nearest
cent or the nearest 1/100th of a share, as the case may be. For purposes of this Section 3, the number of shares of Common Stock outstanding as of a given date shall be the sum of the number of shares of Common Stock (excluding treasury shares, if
any) outstanding. 
  
 e) Notice to Holders.

  
 i. Adjustment to Warrant Conversion
Price. Whenever the Warrant Conversion Price is adjusted pursuant to this Section 3, the Company shall promptly mail to each Holder a notice setting forth the Warrant Conversion Price after such adjustment and setting forth a brief statement of
the facts requiring such adjustment. 
  
 ii.
Notice to Allow Exercise by Holder. If (A) the Company shall declare a dividend (or any other distribution) on the Common Stock; (B) the Company shall declare a special nonrecurring cash dividend on or a 
  

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 redemption of the Common Stock; (C) the Company shall authorize the granting to all holders of the Common
Stock rights or warrants to subscribe for or purchase any shares of capital stock of any class or of any rights; (D) the approval of any stockholders of the Company shall be required in connection with any reclassification of the Common Stock, any
consolidation or merger to which the Company is a party, any sale or transfer of all or substantially all of the assets of the Company, of any compulsory share exchange whereby the Common Stock is converted into other securities, cash or property;
(E) the Company shall authorize the voluntary or involuntary dissolution, liquidation or winding up of the affairs of the Company; then, in each case, the Company shall cause to be mailed to the Holder at its last addresses as it shall appear upon
the Warrant Register of the Company, at least 20 calendar days prior to the applicable record or effective date hereinafter specified, a notice stating (x) the date on which a record is to be taken for the purpose of such dividend, distribution,
redemption, rights or warrants, or if a record is not to be taken, the date as of which the holders of the Common Stock of record to be entitled to such dividend, distributions, redemption, rights or warrants are to be determined or (y) the date on
which such reclassification, consolidation, merger, sale, transfer or share exchange is expected to become effective or close, and the date as of which it is expected that holders of the Common Stock of record shall be entitled to exchange their
shares of the Common Stock for securities, cash or other property deliverable upon such reclassification, consolidation, merger, sale, transfer or share exchange; provided, that the failure to mail such notice or any defect therein or in the
mailing thereof shall not affect the validity of the corporate action required to be specified in such notice. The Holder is entitled to exercise this Warrant during the 20-day period commencing the date of such notice to the effective date of the
event triggering such notice. 
  
 f)
Fundamental Transaction. If, at any time while this Warrant is outstanding, (A) the Company effects any merger or consolidation of the Company with or into another Person, (B) the Company effects any sale of all or substantially all of its
assets in one or a series of related transactions, (C) any tender offer or exchange offer (whether by the Company or another Person) is completed pursuant to which holders of Common Stock are permitted to tender or exchange their shares for other
securities, cash or property, or (D) the Company effects any reclassification of the Common Stock or any compulsory share exchange pursuant to which the Common Stock is effectively converted into or exchanged for other securities, cash or property
(in any such case, a “Fundamental Transaction”), then, upon any subsequent exercise of this Warrant the Holder shall have the right to receive upon conversion of the Warrant Preferred Stock, as applicable, for each Warrant
Conversion Share that would have been issuable upon such exercise and then subsequent conversion absent such Fundamental Transaction, at the option of the Holder, (a) upon conversion of the Warrant Preferred Stock, shares of Common Stock of the
successor or acquiring corporation or of the Company, if it is the surviving corporation, and Alternate Consideration receivable upon or as a result of such 
  

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 reorganization, reclassification, merger, consolidation or disposition of assets by a Holder of the
number of shares of Common Stock for which the underlying Warrant Preferred Stock are convertible immediately prior to such event or (b) cash equal to the value of this Warrant as determined in accordance with the Black-Scholes option pricing
formula (the “Alternate Consideration”). For purposes of any such deemed conversion, the determination of the Warrant Conversion Price shall be appropriately adjusted to apply to such Alternate Consideration based on the amount of
Alternate Consideration issuable in respect of one share of Common Stock in such Fundamental Transaction, and the Company shall apportion the Warrant Conversion Price among the Alternate Consideration in a reasonable manner reflecting the relative
value of any different components of the Alternate Consideration. If holders of Common Stock are given any choice as to the securities, cash or property to be received in a Fundamental Transaction, then the Holder shall be given the same choice as
to the Alternate Consideration it receives upon any conversion or exercise of the Warrant Preferred Stock underlying this Warrant following such Fundamental Transaction. To the extent necessary to effectuate the foregoing provisions, any successor
to the Company or surviving entity in such Fundamental Transaction shall issue to the Holder a new Warrant consistent with the foregoing provisions and evidencing the Holder’s right to exercise such Warrant ultimately into Alternate
Consideration. The terms of any agreement pursuant to which a Fundamental Transaction is effected shall include terms requiring any such successor or surviving entity to comply with the provisions of this paragraph (f) and insuring that this Warrant
(or any such replacement security) will be similarly adjusted upon any subsequent transaction analogous to a Fundamental Transaction. 
  
 g) Exempt Issuance. Notwithstanding the foregoing, no adjustments, Alternate Consideration nor notices shall be made, paid or
issued under this Section 3 in respect of an Exempt Issuance. 
  
 h) Voluntary Adjustment By Company. The Company may at any time during the term of this Warrant reduce the then current Warrant Conversion Price to any amount and for any period of time deemed appropriate by
the Board of Directors of the Company. 
  
 Section 4.
Transfer of Warrant. 
  
 a)
Transferability. Subject to compliance with any applicable securities laws and the conditions set forth in Sections 5(a) and 4(e) hereof and to the provisions of Section 4.1 of the Purchase Agreement, this Warrant and all rights hereunder are
transferable, in whole or in part, upon surrender of this Warrant at the principal office of the Company, together with a written assignment of this Warrant substantially in the form attached hereto duly executed by the Holder or its agent or
attorney and funds sufficient to pay any transfer taxes payable upon the making of such transfer. Upon such surrender and, if required, such payment, the Company shall execute and deliver a new Warrant or Warrants in the name of the assignee or
assignees and in the denomination or denominations specified in such instrument of assignment, and shall issue to the assignor a new Warrant evidencing the portion of this Warrant not so assigned, and this Warrant shall promptly be cancelled. An
Warrant, if properly assigned, may be exercised by a new holder for the purchase of Warrant Preferred Stock without having a new Warrant issued. 
  

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 b) New Warrants. This Warrant may be divided or combined with other Warrants upon
presentation hereof at the aforesaid office of the Company, together with a written notice specifying the names and denominations in which new Warrants are to be issued, signed by the Holder or its agent or attorney. Subject to compliance with
Section 4(a), as to any transfer which may be involved in such division or combination, the Company shall execute and deliver a new Warrant or Warrants in exchange for the Warrant or Warrants to be divided or combined in accordance with such notice.

  
 c) Warrant Register. The Company shall
register this Warrant, upon records to be maintained by the Company for that purpose (the “Warrant Register”), in the name of the record Holder hereof from time to time. The Company may deem and treat the registered Holder of this
Warrant as the absolute owner hereof for the purpose of any exercise hereof or any distribution to the Holder, and for all other purposes, absent actual notice to the contrary 
  
 d) Transfer Restrictions. If, at the time of the surrender of this Warrant in connection with any
transfer of this Warrant, the transfer of this Warrant shall not be registered pursuant to an effective registration statement under the Securities Act and under applicable state securities or blue sky laws, the Company may require, as a condition
of allowing such transfer (i) that the Holder or transferee of this Warrant, as the case may be, furnish to the Company a written opinion of counsel (which opinion shall be in form, substance and scope customary for opinions of counsel in comparable
transactions) to the effect that such transfer may be made without registration under the Securities Act and under applicable state securities or blue sky laws, (ii) that the holder or transferee execute and deliver to the Company an investment
letter in form and substance acceptable to the Company and (iii) that the transferee be an “accredited investor” as defined in Rule 501(a)(1), (a)(2), (a)(3), (a)(7), or (a)(8) promulgated under the Securities Act or a qualified
institutional buyer as defined in Rule 144A(a) under the Securities Act. 
  
 Section 5. Miscellaneous. 
  
 a) Title to the Warrant. Prior to the Termination Date and subject to compliance with applicable laws and Section 4 of this Warrant, this Warrant and all rights hereunder are transferable, in whole or in part,
at the office or agency of the Company by the Holder in person or by duly authorized attorney, upon surrender of this Warrant together with the Assignment Form annexed hereto properly endorsed. The transferee shall sign an investment letter in form
and substance reasonably satisfactory to the Company. 
  
 b) No Rights as Shareholder Until Exercise. This Warrant does not entitle the Holder to any voting rights or other rights as a shareholder of the Company prior to the exercise hereof. Upon the surrender of this Warrant and the
payment of the aggregate principal, the Warrant Preferred Stock so purchased shall be and be deemed to be issued to such Holder as the record owner of such shares as of the close of business on the later of the date of such surrender or payment.

  

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 c) Loss, Theft, Destruction or Mutilation of Warrant. The Company covenants that
upon receipt by the Company of evidence reasonably satisfactory to it of the loss, theft, destruction or mutilation of this Warrant or any certificate relating to the Warrant Preferred Stock, and in case of loss, theft or destruction, of indemnity
or security reasonably satisfactory to it (which, in the case of the Warrant, shall not include the posting of any bond), and upon surrender and cancellation of such Warrant or certificate, if mutilated, the Company will make and deliver a new
Warrant or certificate of like tenor and dated as of such cancellation, in lieu of such Warrant or certificate. 
  
 d) Saturdays, Sundays, Holidays, etc. If the last or appointed day for the taking of any action or the expiration of any right
required or granted herein shall be a Saturday, Sunday or a legal holiday, then such action may be taken or such right may be exercised on the next succeeding day not a Saturday, Sunday or legal holiday. 
  
 e) Authorized Shares. 
  
 The Company covenants that during the period the Warrant is
outstanding, it will reserve from its authorized and unissued Common Stock a sufficient number of shares to provide for the issuance of the shares of Common Stock issuable upon conversion of the Warrant Preferred Stock. The Company further covenants
that its issuance of this Warrant shall constitute full authority to its officers who are charged with the duty of executing certificates to execute and issue the necessary certificates for the Warrant Preferred Stock upon the exercise of the
purchase rights under this Warrant. The Company will take all such reasonable action as may be necessary to assure that such Warrant Preferred Stock and Warrant Conversion Shares may be issued as provided herein without violation of any applicable
law or regulation, or of any requirements of the Trading Market upon which the Common Stock may be listed. 
  
 Except and to the extent as waived or consented to by the Holder, the Company shall not by any action, including, without limitation,
amending its certificate of incorporation or through any reorganization, transfer of assets, consolidation, merger, dissolution, issue or sale of securities or any other voluntary action, avoid or seek to avoid the observance or performance of any
of the terms of this Warrant or the Warrant Preferred Stock, but will at all times in good faith assist in the carrying out of all such terms and in the taking of all such actions as may be necessary or appropriate to protect the rights of Holder as
set forth in this Warrant and the Warrant Preferred Stock against impairment. Without limiting the generality of the foregoing, the Company will (a) take all such action as may be necessary or appropriate in order that the Company may validly and
legally issue fully paid and nonassessable Warrant Preferred Stock upon the exercise of this Warrant and Warrant Conversion Shares upon conversion of the Warrant Preferred Stock, and (b) use commercially reasonable efforts to obtain all such
authorizations, exemptions or consents from any public 
  

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 regulatory body having jurisdiction thereof as may be necessary to enable the Company to perform its
obligations under this Warrant and the Warrant Preferred Stock. 
  
 Before taking any action which would result in an adjustment in the Warrant Preferred Stock for which this Warrant is exercisable or in the Warrant Conversion Price, the Company shall obtain all such authorizations or
exemptions thereof, or consents thereto, as may be necessary from any public regulatory body or bodies having jurisdiction thereof. 
  
 f) Jurisdiction. All questions concerning the construction, validity, enforcement and interpretation of this Warrant shall be
determined in accordance with the provisions of the Purchase Agreement. 
  
 g) Restrictions. The Holder acknowledges that the Warrant Preferred Stock acquired upon the exercise of this Warrant, if not then
registered, will have restrictions upon resale imposed by state and federal securities laws. 
  
 h) Nonwaiver and Expenses. No course of dealing or any delay or failure to exercise any right hereunder on the part of Holder shall
operate as a waiver of such right or otherwise prejudice Holder’s rights, powers or remedies, notwithstanding the fact that all rights hereunder terminate on the Termination Date. If the Company willfully and knowingly fails to comply with any
provision of this Warrant, which results in any material damages to the Holder, the Company shall pay to Holder such amounts as shall be sufficient to cover any costs and expenses including, but not limited to, reasonable attorneys’ fees,
including those of appellate proceedings, incurred by Holder in collecting any amounts due pursuant hereto or in otherwise enforcing any of its rights, powers or remedies hereunder. 
  
 i) Notices. Any notice, request or other document
required or permitted to be given or delivered to the Holder by the Company shall be delivered in accordance with the notice provisions of the Purchase Agreement. 
  
 j) Limitation of Liability. No provision hereof, in the absence of any affirmative action by Holder
to exercise this Warrant or purchase Warrant Preferred Stock, and no enumeration herein of the rights or privileges of Holder, shall give rise to any liability of Holder for the purchase price of any Common Stock or as a stockholder of the Company,
whether such liability is asserted by the Company or by creditors of the Company. 
  
 k) Remedies. Holder, in addition to being entitled to exercise all rights granted by law, including recovery of damages, will be
entitled to specific performance of its rights under this Warrant. The Company agrees that monetary damages would not be adequate compensation for any loss incurred by reason of a breach by it of the provisions of this Warrant and hereby agrees to
waive the defense in any action for specific performance that a remedy at law would be adequate. 
  

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 l) Successors and Assigns. Subject to applicable securities laws, this Warrant and
the rights and obligations evidenced hereby shall inure to the benefit of and be binding upon the successors of the Company and the successors and permitted assigns of Holder. The provisions of this Warrant are intended to be for the benefit of all
Holders from time to time of this Warrant and shall be enforceable by any such Holder or holder of Warrant Preferred Stock. 
  
 m) Amendment. This Warrant may be modified or amended or the provisions hereof waived with the written consent of the Company and
the Holder. 
  
 n) Severability.
Wherever possible, each provision of this Warrant shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this Warrant shall be prohibited by or invalid under applicable law, such provision
shall be ineffective to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions or the remaining provisions of this Warrant. 
  
 o) Headings. The headings used in this Warrant are for the convenience of reference only and shall
not, for any purpose, be deemed a part of this Warrant. 
  
 ******************** 
  

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 IN WITNESS WHEREOF, the Company has caused this Warrant to be executed by its officer thereunto duly
authorized. 
  
 Dated: December 6, 2004 
  

			
	CAMBRIDGE HEART, INC.
		
	 By:
	 	  

	 Name:
	 	 David A. Chazanovitz

	 Title:
	 	 President and Chief Executive Officer

  

 13 

 NOTICE OF EXERCISE 
  
 TO: CAMBRIDGE HEART, INC. 
  
 (1) The undersigned hereby elects to purchase either (check applicable box): 
  
  ̈
$                     Stated Value of Warrant Preferred Stock of Cambridge Heart, Inc. pursuant to the terms of the attached Warrant (only if
exercised in full); or 
  
  ̈ Warrant Conversion Shares of the Company pursuant to the terms of the attached Warrant (only if exercised in full) 
  
 and tenders herewith payment in full, together with all applicable transfer taxes, if any. 
  
 (2) Payment shall take the form of (check applicable box): 
  
  ̈ in lawful money of the United States; or 
  
  ̈ the cancellation of such number of Warrant Conversion Shares as is necessary, in accordance with the formula
set forth in subsection 2(b), to exercise this Warrant with respect to the maximum number of Warrant Conversion Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 2(b). 
  
 (3) Please issue a certificate or certificates representing said Warrant
Preferred Stock (or Warrant Conversion Shares) in the name of the undersigned or in such other name as is specified below: 
  
 _______________________________________ 
  
 The Warrant Preferred Stock (or Warrant Conversion Shares) shall be delivered to the following: 
  
 _______________________________________ 
  
  
 _______________________________________

  
  
 _______________________________________ 
  
  
 (4) Accredited Investor. The undersigned is an “accredited investor” as defined in Regulation D promulgated under the Securities Act of
1933, as amended. 
  
 [SIGNATURE OF HOLDER] 
  

	
	 Name of Investing Entity:

	
	  

	 Signature of Authorized Signatory of Investing Entity:

	
	  

	 Name of Authorized Signatory:

	
	  

	 Title of Authorized Signatory:

	
	  

	 Date:

  

 1 

 ASSIGNMENT FORM 
  
 (To assign the foregoing warrant, execute 
 this form and supply required information. 
 Do not use this form to exercise the warrant.) 
  
 FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby
are hereby assigned to 
  
                                       
                                        
                                        
                                   whose address is 
  
                                       
                                        
                                        
                                        
                                        
          .                              
           
  
                                       
                                        
                                        
                                        
                                        
                                        
             
  
 Dated:                     ,
                                       
              
  

							
	 	 	 Holder’s Signature:
	  	  

			
	 	 	 Holder’s Address:
	  	  

			
	 	 	 	  	  

  
 Signature Guaranteed:
                                        
             
  
 NOTE: The signature to this Assignment Form must correspond with the name as it appears on the face of the Warrant, without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank or trust company. Officers of
corporations and those acting in a fiduciary or other representative capacity should file proper evidence of authority to assign the foregoing Warrant.Form of Callable Note Linked to S&P 500 Index due December 7, 2011

 Exhibit 4.1 
  
 [Face of Note] 
  
 Unless this certificate is presented by an authorized representative of The Depository Trust Company, a New York corporation (“DTC”), to the
Company 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 requested by an authorized representative of DTC (and any payment is made to Cede
& Co. or 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. 
  

			
	 CUSIP NO. 949746 JK 8
	 	PRINCIPAL AMOUNT: $                    
	 REGISTERED NO. 1
	 	 

  
 WELLS FARGO &
COMPANY 
  
 Callable Notes Linked to the S&P 500
Index® due December 7, 2011 
  
 WELLS FARGO & COMPANY, a corporation duly organized and existing under
the laws of the State of Delaware (hereinafter called the “Company,” which term includes any successor corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay to CEDE & Co., or registered
assigns, an amount equal to the Maturity Payment Amount (as defined below), 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, on the Stated Maturity Date (as
defined below). This Security shall not bear any interest. 
  
 Any
payments on this Security at Maturity will be made against presentation of this Security at the office or agency of the Company maintained for that purpose in the City of Minneapolis, Minnesota. 
  

 “Standard
& Poor’s®,” “S&P®,” “S&P 500®,” “Standard & Poor’s 500®,” and “500®” are trademarks of The McGraw-Hill Companies, Inc. and have been licensed for use
by the Company. This Security, based on the performance of the S&P 500 Index, is not sponsored, endorsed, sold or promoted by Standard & Poor’s, a division of The McGraw-Hill Companies, Inc. (“S&P”, which term, as used
herein, includes its successors), and S&P makes no representation regarding the advisability of investing in this Security. 

 Determination of Maturity Payment Amount 
  
 “Maturity Payment Amount” shall mean, for each $1,000 principal amount of this Security, the sum of (i) $1,000 and
(ii) the Additional Amount, if any. 
  
 Set forth below are
certain defined terms used in this Security in connection with the determination of the Maturity Payment Amount. 
  
 “Additional Amount” shall mean, for each $1,000 principal amount of this Security, an amount equal to the greater of (i) zero and (ii) the
product of: 
  

	 	•	$1,000; and 

  

	 	•	Final Index Level – Initial Index Level 

                         Initial Index Level 
  
 “Business Day” shall mean any day other than a Saturday, Sunday or a day on which banking institutions are
authorized or required by law, regulation or executive order to close in New York City or Minneapolis, Minnesota. 
  
 “Calculation Agent Agreement” shall mean the Calculation Agent Agreement dated as of December 7, 2004 between the Company and the Calculation
Agent, as amended from time to time. 
  
 “Calculation
Agent” shall mean the Person that has entered into the Calculation Agent Agreement with the Company providing for, among other things, the determination of the Additional Amount, if any, the Final Index Level and the Maturity Payment Amount,
which term shall, unless the context otherwise requires, include its successors under such Calculation Agent Agreement. The initial Calculation Agent shall be Wells Fargo Securities, LLC. Pursuant to the Calculation Agent Agreement, the Company may
appoint a different Calculation Agent from time to time after the initial issuance of the Securities of this series without the consent of the Holders of the Securities of this series and without notifying the Holders of the Securities of this
series. 
  
 “Calculation Day” means any Trading Day on
which a Market Disruption Event has not occurred. 
  
 “Closing Level” shall mean, on any date, the last reported level of the S&P 500 Index at 4:00 p.m., New York City time, on such date as reported by S&P; provided, however, that in the event that S&P discontinues
publication of the S&P 500 Index, the Closing Level will be determined in the manner set forth in this Security under “Discontinuance Of The S&P 500 Index; Alteration Of Method Of Calculation.” 
  
 “Calculation Period” shall mean the period of three Calculation
Days beginning on and including the fourth Trading Day before December 7, 2011 to and including the second Trading Day before December 7, 2011; provided, however, that if one or more of such Trading Days is not a Calculation Day, the
Calculation Period shall be extended to such date as is necessary so that the Calculation Period consists of three Calculation Days. 
  

 2 

 “Final Index Level” shall mean the average (i.e., arithmetic mean) of the Closing Levels of the
S&P 500 Index determined on each of the three Calculation Days during the Calculation Period. 
  
 “Initial Index Level” shall mean 1173.82. 
  
 A “Market Disruption Event” with respect to the S&P 500 Index will occur on any day if the Calculation Agent determines any of the
following: 
  

	 	•	A material suspension or material limitation of trading in 20% or more of the underlying stocks which then comprise the S&P 500 Index or any successor index has occurred on that
day, in each case, during the one-half hour period preceding the close of trading on the primary organized U.S. exchange or trading system on which those stocks are traded or, if in the case of a common stock not listed or quoted in the United
States, on the primary non-U.S. exchange, trading system or market for that security. Limitations on trading during significant market fluctuations imposed pursuant to New York Stock Exchange Rule 80B or any applicable rule or regulation enacted or
promulgated by The New York Stock Exchange, any other exchange, trading system or market, any other self regulatory organization or the Securities and Exchange Commission of similar scope or as a replacement for Rule 80B, may be considered material.
A “trading system” includes bulletin board services. 

  

	 	•	A material suspension or material limitation has occurred on that day, in each case, during the one-half hour period preceding the close of trading in options or futures contracts
related to the S&P 500 Index or any successor index, whether by reason of movements in price exceeding levels permitted by an exchange, trading system or market on which those options or futures contracts are traded or otherwise.

  

	 	•	Information is unavailable on that date, through a recognized system of public dissemination of transaction information, during the one-half hour period preceding the close of
trading, of accurate price, volume or related information in respect of 20% or more of the underlying stocks which then comprise the S&P 500 Index or any successor index or in respect of options or futures contracts related to the S&P 500
Index or any successor index, in each case traded on any major U.S. exchange or trading system or, in the case of securities of a non-U.S. issuer, traded on the primary non-U.S. exchange, trading system or market for that security.

  
 For purposes of determining whether a Market Disruption Event
has occurred: 
  

	 	•	a limitation on the hours or number of days of trading will not constitute a Market Disruption Event if it results from an announced change in the regular business hours of the
relevant exchange, trading system or market; and 

  

	 	•	close of trading means 4:00 p.m., New York City time. 

  

 3 

 “S&P 500 Index” shall mean the S&P 500 Index as calculated by S&P. 
  
 “Stated Maturity Date” shall mean December 7, 2011; provided,
however, that if a Market Disruption Event occurs during the period beginning on and including the fourth Trading Day before December 7, 2011 to and including the second Trading Day before December 7, 2011 such that one or more of such Trading
Days is not a Calculation Day, the Stated Maturity Date will be postponed until two Business Days after the final day of the Calculation Period. 
  
 “Trading Day” shall mean each Monday, Tuesday, Wednesday, Thursday and Friday that is a day on which The New York Stock Exchange, The Nasdaq
National Market and the American Stock Exchange are open for trading. 
  
 Discontinuance Of The S&P 500 Index; Alteration Of Method Of Calculation 
  
 If S&P discontinues publication of the S&P 500 Index and S&P or another entity publishes a successor or substitute index that the Calculation
Agent determines, in its sole discretion, to be comparable to the discontinued S&P 500 Index, then any subsequent Closing Level will be determined by reference to the level of such successor or substitute index (in any such case, a
“successor index”) at 4:00 p.m., New York City time, on the date that any such subsequent Closing Level is to be determined. 
  
 Upon any selection by the Calculation Agent of a successor index, the Company will promptly give notice to the Holders of the Securities of this series.

  
 If S&P discontinues publication of the S&P 500 Index
prior to, and such discontinuance is continuing on, the date that any Closing Level is to be determined and the Calculation Agent determines that no successor index is available at such time, then, on such date, the Calculation Agent will determine
each subsequent Closing Level to be used in computing the Additional Amount. Each such Closing Level will be computed by the Calculation Agent in accordance with the formula for and method of calculating the S&P 500 Index last in effect prior to
such discontinuance, using the Closing Price (or, if trading in the relevant security has been materially suspended or materially limited, its good faith estimate of the Closing Price that would have prevailed but for such suspension or limitation)
at the close of the principal trading session on such date of each security most recently comprising the S&P 500 Index on the primary organized U.S. exchange or trading system. “Closing Price” means, with respect to any security on any
date, the last reported sales price regular way on such date or, in case no such reported sale takes place on such date, the average of the reported closing bid and asked prices regular way on such date, in either case on the primary organized U.S.
exchange or trading system on which such security is then listed or admitted to trading. 
  
 If a successor index is selected or the Calculation Agent calculates a Closing Level as a substitute for the S&P 500 Index, such successor index or Closing Level will be used as a substitute for the S&P 500
Index for all purposes, including for purposes of determining whether a Market Disruption Event exists. 
  

 4 

 If at any time the method of calculating the S&P 500 Index or a successor index, or the Closing Level
thereof, is changed in a material respect, or if the S&P 500 Index or a successor index is in any other way modified so that such index does not, in the opinion of the Calculation Agent, fairly represent the value of the S&P 500 Index or
such successor index had such changes or modifications not been made, then the Calculation Agent will, at the close of business in New York City on the date that any Closing Level is to be determined, make such calculations and adjustments as, in
the good faith judgment of the Calculation Agent, may be necessary in order to arrive at a value of a stock index comparable to the S&P 500 Index or such successor index, as the case may be, as if such changes or modifications had not been made,
and calculate the Closing Level and the Additional Amount with reference to the S&P 500 Index or such successor index, as adjusted. Accordingly, if the method of calculating the S&P 500 Index or a successor index is modified so that the
level of such index is a fraction of what it would have been if it had not been modified (for example, due to a split in the index), then the Calculation Agent will adjust such index in order to arrive at a level of the S&P 500 Index or such
successor index as if it had not been modified (for example, as if such split had not occurred). 
  
 Calculation Agent 
  
 The Calculation Agent will determine the Additional Amount, if any, and the Maturity Payment Amount. In addition, the Calculation Agent will: 

 

	 	•	determine if adjustments are required to the Closing Level under the circumstances described in this Security; 

  

	 	•	if publication of the S&P 500 Index is discontinued, select a successor index or, if no successor index is available, determine the Final Index Level; and

  

	 	•	determine whether a Market Disruption Event has occurred and whether the Stated Maturity Date will be postponed. 

  
 The Company covenants that, so long as any of the Securities of this series
are Outstanding, there shall at all times be a Calculation Agent (which shall be a broker-dealer, bank or other financial institution) with respect to the Securities of this series. 
  
 All determinations made by the Calculation Agent with respect to the Securities of this series will be at the sole
discretion of the Calculation Agent and, in the absence of manifest error, will be conclusive for all purposes and binding on the Company and the Holders of the Securities of this series. All percentages and other amounts resulting from any
calculation with respect to the Securities of this series will be rounded at the Calculation Agent’s discretion. 
  
 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 referred to on the reverse hereof by manual signature or its duly authorized agent under the Indenture referred 
  

 5 

 to on the reverse hereof by manual signature, this Security shall not be entitled to any benefit under the Indenture or
be valid or obligatory for any purpose. 
  
 [The remainder of
this page has been left intentionally blank.] 
  

 6 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed under its corporate
seal. 
  
 DATED:
                             
  

					
	 	 	 WELLS FARGO & COMPANY

			
	 	 	 By:
	 	  

	 	 	 	 	 Howard I. Atkins

	 	 	 	 	 Executive Vice President and

	 	 	 	 	 Chief Financial Officer

			
	 [SEAL]
	 	 	 	 
			
	 	 	 Attest:
	 	  

	 	 	 	 	 Laurel A. Holschuh

	 	 	 	 	 Senior Vice President and Secretary

  
 TRUSTEE’S CERTIFICATE OF

 AUTHENTICATION 
  
 This is one of the Securities of the 
 series designated therein described 
 in the within-mentioned Indenture. 
  
 CITIBANK, N.A., 
       as Trustee 

 

			
	 By:
	 	  

	 	 	 Authorized Signature

		
	 	 	                 OR

	
	 WELLS FARGO BANK, N.A.,

	     as Authenticating Agent for the Trustee

		
	 By:
	 	  

	 	 	 Authorized Signature

  

 7 

 [Reverse of Note] 
  

WELLS FARGO & COMPANY 
  
 Callable Notes Linked to the S&P 500 Index® due December 7, 2011 
  
 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 an indenture dated as of July 21, 1999, as amended or supplemented from time to time (herein called the “Indenture”), between the Company and Citibank, N.A., as Trustee (herein called the “Trustee,” which term
includes any successor trustee under the Indenture), to which Indenture and all indentures supplemental thereto reference is hereby made 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. This Security is one of the series designated on the face hereof, limited in aggregate principal
amount to $                    ; provided, however, that the Company may, so long as no Event of Default has occurred and is
continuing, without the consent of the Holders of the Securities of this series, issue additional Securities with the same terms as the Securities of this series, and such additional Securities shall be considered part of the same series under the
Indenture as the Securities of this series. 
  
 The Securities of
this series are not subject to repayment at the option of the Holder hereof prior to the Stated Maturity Date. The Securities of this series will not be entitled to any sinking fund. 
  
 The Securities of this series are redeemable at the option of the Company, in whole but not in part, on the dates indicated
below or on any date during the period indicated below (each, a “Redemption Date”). The redemption prices for each $1,000 principal amount of the Securities of this series (as indicated on the face of the Securities of this series as the
“Principal Amount”) to be redeemed are set forth in the table below (each, a “Redemption Price”): 
  

				
	 Date/Period

	  	Redemption Price

	 December 7, 2005
	  	$	1,100
	 December 7, 2006
	  	$	1,200
	 December 7, 2007
	  	$	1,300
	 December 8, 2008
	  	$	1,400
	 During the period beginning on December 7, 2009 to and including December 7, 2011
	  	$	1,500

  
 The final date on
which the Securities of this series may be redeemed will not change due to the occurrence of a Market Disruption Event. 
  

 8 

 Notice of any redemption will be mailed at least 30 days but not more than 60 days before the Redemption
Date to each Holder of the Securities of this series to be redeemed. 
  
 The Company agrees, to the extent permitted by law, not to voluntarily claim the benefits of any laws concerning usurious rates of interest against a Holder of Securities of this series. 
  
 If an Event of Default, as defined in the Indenture, with respect to
Securities of this series shall occur and be continuing, the Maturity Payment Amount (calculated as set forth in the next sentence) of the Securities of this series may be declared due and payable in the manner and with the effect provided in the
Indenture. The amount payable to the Holder hereof upon any acceleration permitted under the Indenture will be equal to the Maturity Payment Amount hereof calculated as though the date of acceleration was the Stated Maturity Date. Upon payment of
the amount so declared due and payable, all of the Company’s obligations in respect of payment of the Maturity Payment Amount shall terminate. The Securities of this series will not bear a default rate of interest after the occurrence of an
Event of Default or an acceleration under the Indenture. 
  
 The
Company agrees, and by acceptance of a beneficial ownership interest in this Security each beneficial owner of this Security will be deemed to have agreed, for United States federal income tax purposes (i) to treat this Security as a single debt
instrument subject to the Treasury regulations governing contingent payment debt instruments, (ii) to report all income (or loss) with respect to this Security according to those Treasury regulations, and (iii) to be bound by the Company’s
determination of the “comparable yield” and the “projected payment schedule” (within the meaning of such Treasury regulations) for this Security, unless such beneficial owner timely discloses and justifies in its federal income
tax return the use of a different comparable yield and projected payment schedule. 
  
 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 of each
series 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 the Securities at the time Outstanding of all series to be affected, acting together. The
Indenture also contains provisions permitting the Holders of a majority in principal amount of the Securities of all series at the time Outstanding affected by certain provisions of the Indenture, acting together, on behalf of the Holders of all
Securities of such series, to waive compliance by the Company with those provisions of the Indenture. Certain past defaults under the Indenture and their consequences may be waived under the Indenture by the Holders of a majority in principal amount
of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such series. Solely for the purpose of determining whether any consent, waiver, notice or other action or Act to be taken or given by the Holders
of Securities pursuant to the Indenture has been given or taken by the Holders of Outstanding Securities in the requisite aggregate principal amount, the principal amount of this Security will be deemed to be equal to the amount set forth on the
face hereof as the “Principal Amount” hereof. 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. 
  

 9 

 Section 403 and Article Fifteen of the Indenture and the provisions of clause (ii) of Section 401(1)(B)
of the Indenture, relating to defeasance at any time of (a) the entire indebtedness on this Security and (b) certain restrictive covenants and certain Events of Default, upon compliance by the Company with certain conditions set forth therein, shall
not apply to this Security. The remaining provisions of Section 401 of the Indenture shall apply to this Security. 
  
 Upon due presentment for registration of transfer of this Security at the office or agency of the Company in the City of Minneapolis, Minnesota, a new
Security or Securities of this series in authorized denominations for an equal aggregate principal amount will be issued to the transferee in exchange herefor, as provided in the Indenture and subject to the limitations provided therein and to the
limitations described below, without charge except for any tax or other governmental charge imposed in connection therewith. 
  
 This Security is exchangeable for definitive Securities in registered form only if (x) the Depositary notifies the Company that it is unwilling or unable
to continue as Depositary for this Security or if at any time the Depositary ceases to be a clearing agency registered under the Securities Exchange Act of 1934, as amended, and a successor depositary is not appointed within 90 days after the
Company receives such notice or becomes aware of such ineligibility, (y) the Company in its sole discretion determines that this Security shall be exchangeable for definitive Securities in registered form and notifies the Trustee thereof or (z) an
Event of Default with respect to the Securities represented hereby has occurred and is continuing. If this Security is exchangeable pursuant to the preceding sentence, it shall be exchangeable for definitive Securities in registered form, having the
same terms and of authorized denominations aggregating a like amount. 
  
 This Security may not be transferred except as a whole by the Depositary to a nominee of the Depositary or by a nominee of the Depositary to the Depositary or another nominee of the Depositary or by the Depositary or any such nominee to a
successor of the Depositary or a nominee of such successor. Except as provided above, owners of beneficial interests in this Security will not be entitled to receive physical delivery of Securities in definitive form and will not be considered the
Holders hereof for any purpose under the Indenture. 
  
 No
reference herein to the Indenture and no provision of the Indenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay the Maturity Payment Amount at the times and place, and in the coin or currency,
herein prescribed, except as otherwise provided in this Security. 
  
 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. 
  
 No recourse shall be had for the payment of the Maturity Payment Amount, or for any claim based on this Security, or otherwise in respect hereof, or based
on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer or director, as such, past, present or future, of the Company or any successor corporation, whether by virtue of any
constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability being, by the acceptance hereof and as part of the consideration for the issuance hereof, expressly waived and released.

  

 10 

 All terms used in this Security which are defined in the Indenture shall have the meanings assigned to
them in the Indenture unless otherwise defined in this Security. 
  
 This Security shall be governed by and construed in accordance with the laws of the State of New York. 
  

 11 

 ABBREVIATIONS 
  
 The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they
were written out in full according to applicable laws or regulations: 
  

					
	 TEN COM
	 	—	  	 as tenants in common

	 TEN ENT
	 	—	  	 as tenants by the entireties

	 JT TEN
	 	—	  	 as joint tenants with right of survivorship and not as tenants in common

  

							
	 UNIF GIFT MIN ACT —
	 	  

	 	Custodian	  	  

	 	 	(Cust)	 	 	  	(Minor)

  
 Under Uniform Gifts to Minors Act

  

	
	  

	                             (State)

  
 Additional
abbreviations may also be used though not in the above list. 
  
 FOR VALUE RECEIVED, the undersigned hereby sell(s) and transfer(s) unto 
  
 Please Insert Social Security or 
 Other Identifying Number of Assignee 
  

	
	  

  

	
	
 
	

	 
	

  
 (PLEASE
PRINT OR TYPE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE)

  

 12 

 the within Security of WELLS FARGO & COMPANY and does hereby irrevocably constitute and appoint
                     attorney to transfer the said Security on the books of the Company, with full power of substitution in the premises.

  

					
	 Dated:
                            
	 	 
			
	 	 	 	 	  

			
	 	 	 	 	  

  
 NOTICE: The signature to this
assignment must correspond with the name as written upon the face of the within instrument in every particular, without alteration or enlargement or any change whatever. 
  

 13

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