Document:

EX-4.8

 Exhibit 4.8 

[FORM OF FACE OF NOTE] 
 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 IS EXCHANGEABLE FOR SECURITIES REGISTERED IN THE NAME OF A PERSON OTHER THAN THE
DEPOSITARY OR ITS NOMINEE ONLY IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE AND, UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR SECURITIES IN DEFINITIVE REGISTERED FORM, THIS SECURITY MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY
THE DEPOSITARY TO THE 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 DEPOSITARY OR TO A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.

 UNLESS THIS SECURITY 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 SECURITY ISSUED IS REGISTERED IN THE NAME OF CEDE & CO., OR SUCH OTHER NAME AS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO
CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUIRED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL SINCE THE REGISTERED OWNER HEREOF, CEDE &
CO., HAS AN INTEREST HEREIN. 

 CUSIP No.: 071813CV9 

ISIN: US071813CV90 
 BAXTER
INTERNATIONAL INC. 
 3.132% Senior Notes due 2051 
  

			
	No.	  	$                    

 Baxter International Inc., a Delaware corporation (the “Company”), for value received, hereby
promises to pay to CEDE & CO. or registered assigns, at the office or agency of the Company in the City of New York, the principal sum set forth on Schedule I attached hereto (as the same may be revised from time to time) on
December 1, 2051, in such coin or currency of the United States of America as at the time of payment shall be legal tender for the payment of public and private debts, and to pay interest, semiannually on June 1 and December 1 of each
year, commencing on December 1, 2022, on said principal sum at said office or agency, in like coin or currency, at the rate per annum specified in the title of this Note, from the June 1 and December 1, as the case may be, next
preceding the date of this Note to which interest has been paid on the Notes, unless the date hereof is a date to which interest has been paid on the Notes, in which case from the date of this Note, or unless no interest has been paid on the Notes,
in which case from December 1, 2021 until payment of said principal sum has been made or duly provided for; provided, that payment of interest may be made at the option of the Company by check mailed to the address of the person entitled
thereto as such address shall appear on the Security Register or by wire transfer to an account maintained by the payee with a bank located in the United States. 

Notwithstanding the foregoing, if the date hereof is after May 15 or November 15, as the case may be, and before the following
June 1 or December 1, this Note shall bear interest from such June 1 and December 1; provided, that, if the Company shall default in the payment of interest due on such June 1 and December 1, then this Note
shall bear interest from the next preceding June 1 or December 1, to which interest has been paid on the Notes or, if no interest has been paid on the Notes, from December 1, 2021. The interest so payable on any June 1 or
December 1, will, subject to certain exceptions provided in the Indenture referred to on the reverse hereof, be paid to the person in whose name this Note is registered at the close of business on May 15 or November 15 (whether or not
a Business Day (as defined herein)), as the case may be, preceding such June 1 or December 1. Interest on this Note will be calculated on the basis of a 360-day year of twelve 30-day months. 
 Reference is made to the further provisions of this Note set forth on the reverse
hereof. Such further provisions shall for all purposes have the same effect as though fully set forth at this place. 
 This Note shall not
be valid or become obligatory for any purpose until the certificate of authentication hereon shall have been signed by the Trustee under the Indenture referred to on the reverse hereof. 

 IN WITNESS WHEREOF, Baxter International Inc. has caused this instrument to be duly executed
on the date set forth below. 
 Dated: 
  

			
	BAXTER INTERNATIONAL INC.
		
	By:	 	 
		 	Name:
		 	Title:

 [FORM OF CERTIFICATE OF AUTHENTICATION] 

CERTIFICATE OF AUTHENTICATION 

This is one of the Securities of the series designated herein issued under the within-mentioned Indenture. 

 

			
	U.S. BANK TRUST COMPANY, NATIONAL ASSOCIATION, as Trustee
		
	By:	 	 
		 	Authorized Signatory
	
	Dated:

 REVERSE OF NOTE 

BAXTER INTERNATIONAL INC. 

3.132% Senior Notes due 2051 

This Note is one of a duly authorized issue of Securities of the Company of the series hereinafter specified, all issued or to be issued under
and pursuant to an Indenture, dated as of December 1, 2021, as supplemented by the First Supplemental Indenture, dated as of December 1, 2021 (both together herein called the “Indenture”), between the Company and U.S. Bank
Trust Company, National Association, as successor in interest to U.S. Bank National Association, 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 description of the rights, limitations of rights, obligations, duties and immunities thereunder of the Trustee, the Company and the Holders of the Securities. This Note is one of a
series of Securities of the Company designated as the 3.132% Senior Notes due 2051 (the “Notes”), initially limited in aggregate principal amount of $750,000,000, subject to the issuance of additional Notes as provided in the
Indenture. Terms used but not defined herein shall have the respective meanings set forth in the Indenture. 
 If any Interest Payment Date,
maturity date or redemption date, of this Note falls on a day that is not a Business Day, payment will be made on the next succeeding Business Day, and no interest will accrue for the period from and after such Interest Payment Date, maturity date
or redemption date, as the case may be, to the next succeeding Business Day. As used in this Note, the term “Business Day” means each Monday, Tuesday, Wednesday, Thursday and Friday which is not a day on which banking institutions
in the City of New York are authorized or obligated by or pursuant to law, regulation or executive order to close. 
 The Indenture contains
provisions for the defeasance at any time of the entire indebtedness of the Notes or certain covenants set forth in the Indenture applicable to the Notes upon compliance by the Company of certain conditions set forth therein, which provisions apply
to this Note. 
 This Note is redeemable in whole at any time or in part, from time to time, at the option of the Company, prior to
June 1, 2051 (six months prior to the maturity date) (the “Par Call Date”), at a make whole redemption price equal to the greater of: 

(i) 100% of the principal amount of the Notes to be redeemed plus accrued and unpaid interest, if any, to, but excluding, the
date of redemption, and 
 (ii) the sum of the present values of the principal amount of the Notes to be redeemed and the
scheduled payments of interest thereon (exclusive of interest accrued to the date of redemption) from the redemption date to the Par Call Date, discounted to the redemption date on a semiannual basis (assuming a
360-day year consisting of twelve 30-day months) at the Treasury Rate plus 20 basis points, plus accrued and unpaid interest, if any, to, but excluding, the date of
redemption. 
 “Treasury Rate” means, with respect to any redemption date, the rate per annum equal to the semiannual
equivalent yield to maturity of the Comparable Treasury Issue, assuming a price for the Comparable Treasury Issue (expressed as a percentage of its principal amount) equal to the Comparable Treasury Price for such redemption date. 

 “Comparable Treasury Issue” means the United States Treasury security
selected by an Independent Investment Banker as having an actual or interpolated maturity comparable to the remaining term of the Notes to be redeemed calculated as if the maturity date of the Notes were the Par Call Date (the “Remaining
Life”) that would be utilized, at the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable maturity to the Remaining Life of the Notes. 

“Comparable Treasury Price” means, with respect to any redemption date, (1) the average of four Reference Treasury
Dealer Quotations for such redemption date, after excluding the highest and lowest such Reference Treasury Dealer Quotations, or (2) if the Company obtains fewer than four such Reference Treasury Dealer Quotations, the average of all such
quotations. 
 “Independent Investment Banker” means one of the Reference Treasury Dealers appointed by the Company. 

“Reference Treasury Dealers” means (1) J.P. Morgan Securities LLC, Citigroup Global Markets Inc. and their
respective successors; provided, however, that if any of the foregoing shall cease to be a primary U.S. government securities dealer (“Primary Treasury Dealer”), the Company shall substitute another nationally recognized
investment banking firm that is a Primary Treasury Dealer, and (2) at the option of the Company, additional Primary Treasury Dealers selected by the Company. 

“Reference Treasury Dealer Quotations” means, with respect to each Reference Treasury Dealer and any redemption date, the
average, as determined by the Company, of the bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted in writing to the Company by such Reference Treasury Dealer at
5:00 p.m. New York City time on the third Business Day preceding such redemption date. 
 On or after the Par Call Date, this Note is
redeemable in whole at any time or in part, from time to time, at the option of the Company, at a redemption price equal to 100% of its principal amount, plus accrued and unpaid interest thereon to the date of redemption. 

Any redemption made at the option of the Company (an “Optional Redemption”) shall be made upon not less than 10 nor more than
60 days’ prior notice before the redemption date to the Holders. Any such notice of redemption may, in the Company’s discretion, be given subject to the satisfaction of one or more conditions precedent. In that case, such notice of
redemption shall describe each such condition, and such notice may be rescinded in the event that any or all such conditions shall not have been satisfied or waived by the Company by the relevant redemption date. If the Notes are only partially
redeemed by the Company pursuant to an Optional Redemption, the Notes to be redeemed shall be selected by such method as the Trustee shall deem fair and appropriate and in accordance with the Indenture, provided, however, that in the case of
Notes in global form such selection shall be made in accordance with the procedures of the applicable Depositary. In the event of redemption of this Note in part only, a new Note or Notes for the unredeemed portion hereof shall be issued in the name
of the Holder hereof upon the cancellation hereof. Unless the Company defaults in payment of the redemption price, on and after the redemption date interest will cease to accrue on the Notes or portions thereof called for redemption. 

 If a Change of Control Triggering Event (as defined below) occurs, unless the Company has
exercised its option to redeem the Notes (as described above), the Company shall be required to make an offer (the “Change of Control Offer”) to each holder of the Notes to repurchase all or any part (equal to $2,000 or an integral
multiple of $1,000 in excess thereof) of that holder’s Notes on the terms set forth below. In the Change of Control Offer, the Company shall be required to offer payment in cash equal to 101% of the aggregate principal amount of Notes
repurchased, plus accrued and unpaid interest, if any, on the Notes repurchased to, but excluding, the date of repurchase (the “Change of Control Payment”), subject to the right of holders of record of the Notes on the relevant
Record Date to receive interest due on the relevant Interest Payment Date. Within 30 days following any Change of Control Triggering Event or, at the option of the Company, prior to any Change of Control, but after public announcement of the
transaction that constitutes or may constitute the Change of Control, a notice shall be mailed (or, with respect to Notes in global form, to the extent permitted or required by applicable Depositary procedures, sent electronically) to holders of the
Notes with a copy to the Trustee describing the transaction that constitutes or may constitute the Change of Control Triggering Event and offering to repurchase the Notes on the date specified in the notice, which date shall be no earlier than
30 days and no later than 60 days from the date such notice is mailed or sent (the “Change of Control Payment Date”). The notice shall, if mailed or sent prior to the date of consummation of the Change of Control, state
that the offer to purchase is conditioned on the Change of Control Triggering Event occurring on or prior to the Change of Control Payment Date. 

On the Change of Control Payment Date, the Company shall, to the extent lawful: 

 

	 	(1)	 accept for payment all Notes or portions of Notes properly tendered pursuant to the Change of Control Offer;

  

	 	(2)	 deposit with the paying agent an amount equal to the Change of Control Payment in respect of all Notes or
portions of Notes properly tendered; and 

  

	 	(3)	 deliver or cause to be delivered to the Trustee the Notes properly accepted together with an Officers’
Certificate stating the aggregate principal amount of Notes or portions of Notes being repurchased. 

 The Company shall
not be required to make a Change of Control Offer upon the occurrence of a Change of Control Triggering Event if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an offer made by the
Company and the third party repurchases all Notes properly tendered and not withdrawn under its offer. In addition, the Company shall not repurchase any Notes if there has occurred and is continuing on the Change of Control Payment Date an Event of
Default, other than a default in the payment of the Change of Control Payment upon a Change of Control Triggering Event. 

 The Company shall comply with the requirements of
Rule 14e-1 under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations
are applicable in connection with the repurchase of the Notes as a result of a Change of Control Triggering Event. To the extent that the provisions of any such securities laws or regulations conflict with the Change of Control Offer provisions of
the Notes, the Company shall comply with those securities laws and regulations and shall not be deemed to have breached its obligations under the Change of Control Offer provisions of the Notes by virtue of any such conflict. 

For purposes of the Change of Control Offer provisions of the Notes, the following definitions shall apply: 

“Change of Control” means the occurrence of any of the following: (1) the consummation of any transaction (including,
without limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section 13(d)(3) of the Exchange Act), other than the Company or one of its subsidiaries, becomes the beneficial owner
(as defined in Rules 13d-3 and 13d-5 under the Exchange Act), directly or indirectly, of more than 50% of the Company’s Voting Stock or other Voting Stock into
which the Company’s Voting Stock is reclassified, consolidated, exchanged or changed, measured by voting power rather than number of shares; (2) the direct or indirect sale, transfer, conveyance or other disposition (other than by way of
merger or consolidation), in one or a series of related transactions, of all or substantially all of the Company’s assets and the assets of its subsidiaries, taken as a whole, to one or more “persons” (as that term is defined in the
Indenture), other than the Company or one of its subsidiaries or (3) the adoption of a plan relating to the Company’s liquidation or dissolution. Notwithstanding the foregoing, a transaction shall not be deemed to be a Change of Control if
(1) the Company becomes a direct or indirect wholly-owned subsidiary of a holding company and (2)(A) the direct or indirect holders of the Voting Stock of such holding company immediately following that transaction are substantially the same as
the holders of the Company’s Voting Stock immediately prior to that transaction or (B) immediately following that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) (other than a holding
company satisfying the requirements of this sentence) is the beneficial owner, directly or indirectly, of more than 50% of the Voting Stock of such holding company. 

“Change of Control Triggering Event” means the occurrence of both a Change of Control and a Rating Event. 

“Investment Grade Rating” means a rating equal to or higher than Baa3 (or the equivalent) by Moody’s and BBB- (or the equivalent) by S&P, and the equivalent investment grade credit rating from any replacement Rating Agency or Rating Agencies. 

“Moody’s” means Moody’s Investors Service, Inc. 

“Rating Agencies” means (1) each of Moody’s and S&P, and (2) if either Moody’s or S&P ceases to
rate the Notes or fails to make a rating of the Notes publicly available for reasons outside of the Company’s control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the
Exchange Act selected by the Company (as certified by a resolution of the Company’s Board of Directors) as a replacement agency for Moody’s or S&P, or both of them, as the case may be. 

 “Rating Event” means the rating on the Notes is lowered by each of the
Rating Agencies and the Notes are rated below an Investment Grade Rating by each of the Rating Agencies on any day within the 60-day period (which 60-day period will be
extended so long as the rating of the Notes is under publicly announced consideration for a possible downgrade by any of the Rating Agencies but no longer than 180 days) after the earlier of (1) the occurrence of a Change of Control and
(2) public notice of the Company’s intention to effect a Change of Control; provided, however, that a Rating Event otherwise arising by virtue of a particular reduction in rating shall not be deemed to have occurred in respect of a
particular Change of Control (and thus shall not be deemed a Rating Event for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to which this definition would otherwise apply do
not announce or publicly confirm to the Company in writing at the Company’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of or arising as a result of, or in respect of, the applicable
Change of Control (whether or not the applicable Change of Control has occurred at the time of the Rating Event). 

“S&P” means S&P Global Ratings, a division of S&P Global, Inc. 

“Voting Stock” means, with respect to any specified “person” (as that term is used in Section 13(d)(3) of the
Exchange Act), as of any date, the capital stock of such person that is at the time entitled to vote generally in the election of the board of directors of such person. 

The Company’s obligation to make a Change of Control Offer as set forth herein shall be subject to the covenant defeasance provisions of
Section 13.02(c) of the Indenture. 
 If an Event of Default, with respect to the Notes shall have occurred and be continuing, the
principal of this Note may be declared due and payable in the manner and with the effect set forth in the Indenture. 
 The Indenture
contains provisions permitting the Company and the Trustee, with the consent of the Holders of not less than a majority in aggregate principal amount of the Securities at the time Outstanding of each series to be affected to execute supplemental
indentures adding any provisions to or changing in any manner or eliminating any of the provisions of the Indenture or of any supplemental indenture or modifying in any manner the rights of the Holders of the Securities of such series subject to the
limitations set forth in the Indenture. It is also provided in the Indenture that, with respect to certain defaults or Events of Default regarding the Securities of any series, the Holders of a majority in aggregate principal amount of the
Securities at the time Outstanding of such series may on behalf of the Holders of all the Securities of such series waive any such past default or Event of Default and its consequences. The preceding sentence shall not, however, apply to a default
in the payment of the principal of or premium, if any, or interest on the Notes. Any such consent or waiver by the Holder of this Note (unless revoked as provided in the Indenture) shall be conclusive and binding upon such Holder and upon all future
Holders and owners of this Note and any Notes which may be issued in exchange or substitution herefor, irrespective of whether or not any notation thereof is made upon this Note or such other Notes. 

 No reference herein to the Indenture and no provision of this Note or of the Indenture shall
alter or impair the obligations of the Company, which are absolute and unconditional, to pay the principal of, and any premium and interest on, this Note in the manner and at the respective times herein provided. 

The Notes are issuable in registered form without coupons in denominations of $2,000 and any multiple of $1,000 in excess thereof. In the
manner and subject to the limitations provided in the Indenture, but without the payment of any service charge, Notes may be exchanged for a like aggregate principal amount of Notes of other authorized denominations at the office or agency of the
Trustee in the City of New York. 
 There is no sinking fund for the retirement of the Notes. 

Upon due presentment for registration of transfer of this Note at the office or agency of the Trustee in the City of New York, a new Note or
Notes of authorized denominations for an equal aggregate principal amount will be issued to the transferee in exchange therefor, subject to the limitations provided in the Indenture, without charge except for any tax or other governmental charge
imposed in connection therewith. 
 Prior to due presentment for registration of transfer, the Company, the Trustee and any agent of the
Company, or the Trustee may treat the registered Holder hereof as the owner of this Note (whether or not this Note shall be overdue), for the purpose of receiving payment of the principal hereof and premium, if any, and subject to the provisions on
the face hereof, interest hereon, and for all other purposes, and neither the Company, nor the Trustee nor any agent of the Company, or the Trustee shall be affected by any notice to the contrary. 

No recourse under or upon any obligation, covenant or agreement contained in the Indenture or any indenture supplemental thereto or in any
Note, or because of any indebtedness evidenced thereby, shall be had against any incorporator or against any past, present or future stockholder, employee, officer or director, as such, of the Company or of any successor corporation, either directly
or through 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 and any and all such claims being expressly
waived and released as a condition of, and as a consideration for, the execution of the supplement to the Indenture and issue hereof of the Notes. 

This Note is the senior unsecured and unsubordinated obligation of the Company and will rank on parity with all other unsecured and
unsubordinated indebtedness of the Company, including any other Securities issued under the Indenture. 

 [FORM OF TRANSFER NOTICE] 

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

Insert Taxpayer Identification No. 
  

	
	
	 
	Please print or typewrite name and address including zip code of assignee
	
	 
	the within Note and all rights thereunder, hereby irrevocably constituting and appointing attorney to transfer said Note on the books of
	
	 
	the Company with full power of substitution in the premises.

  

			
	 By:
	 	 

			
		
	 Date:
	 	 

 Schedule I 

BAXTER INTERNATIONAL INC. 

3.132% Senior Notes due 2051 
 No. 

The initial principal amount of this Note is
$                        . 
  

							
	 Date
	  	Principal Amount	  	Notation Explaining Principal
Amount Recorded	  	Authorized Signature of
Trustee or CustodianEX-4.9

 Exhibit 4.9 

[FORM OF FACE OF NOTE] 
 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 IS EXCHANGEABLE FOR SECURITIES REGISTERED IN THE NAME OF A PERSON OTHER THAN THE
DEPOSITARY OR ITS NOMINEE ONLY IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE AND, UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR SECURITIES IN DEFINITIVE REGISTERED FORM, THIS SECURITY MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY
THE DEPOSITARY TO THE 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 DEPOSITARY OR TO A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.

 UNLESS THIS SECURITY 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 SECURITY ISSUED IS REGISTERED IN THE NAME OF CEDE & CO., OR SUCH OTHER NAME AS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO
CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUIRED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL SINCE THE REGISTERED OWNER HEREOF, CEDE &
CO., HAS AN INTEREST HEREIN. 

 CUSIP No.: 071813CY3 

ISIN: US071813CY30 
 BAXTER
INTERNATIONAL INC. 
 Floating Rate Senior Notes due 2023 

 

			
	No.	 	$____________

 Baxter International Inc., a Delaware corporation (the “Company”), for value received, hereby
promises to pay to CEDE & CO. or registered assigns, at the office or agency of the Company in the City of New York, the principal sum set forth on Schedule I attached hereto (as the same may be revised from time to time) on
December 1, 2023, in such coin or currency of the United States of America as at the time of payment shall be legal tender for the payment of public and private debts, and to pay interest, quarterly on March 1, June 1,
September 1 and December 1 of each year, commencing on September 1, 2022, on said principal sum at said office or agency, in like coin or currency, at the rate per annum specified on the reverse of this Note, from the March 1,
June 1, September 1 and December 1, as the case may be, next preceding the date of this Note to which interest has been paid on the Notes, unless the date hereof is a date to which interest has been paid on the Notes, in which case
from the date of this Note, or unless no interest has been paid on the Notes, in which case from December 1, 2021 until payment of said principal sum has been made or duly provided for; provided, that payment of interest may be made at the
option of the Company by check mailed to the address of the person entitled thereto as such address shall appear on the Security Register or by wire transfer to an account maintained by the payee with a bank located in the United States. 

Notwithstanding the foregoing, if the date hereof is after February 15, May 15, August 15 or November 15, as the case may
be, and before the following March 1, June 1, September 1 or December 1, this Note shall bear interest from such March 1, June 1, September 1 and December 1; provided, that, if the Company shall
default in the payment of interest due on such March 1, June 1, September 1 and December 1, then this Note shall bear interest from the next preceding March 1, June 1, September 1 or December 1, to which
interest has been paid on the Notes or, if no interest has been paid on the Notes, from December 1, 2021. The interest so payable on any March 1, June 1, September 1 or December 1, will, subject to certain exceptions
provided in the Indenture referred to on the reverse hereof, be paid to the person in whose name this Note is registered at the close of business on February 15, May 15, August 15 or November 15 (whether or not a Business Day (as
defined herein)), as the case may be, preceding such March 1, June 1, September 1 or December 1. Interest on this Note will be calculated on the basis of a 360-day year and the actual number of
days in the Observation Period. 
 Reference is made to the further provisions of this Note set forth on the reverse hereof. Such further
provisions shall for all purposes have the same effect as though fully set forth at this place. 
 This Note shall not be valid or become
obligatory for any purpose until the certificate of authentication hereon shall have been signed by the Trustee under the Indenture referred to on the reverse hereof. 

 IN WITNESS WHEREOF, Baxter International Inc. has caused this instrument to be duly executed
on the date set forth below. 
 Dated: 
  

			
	BAXTER INTERNATIONAL INC.
		
	By:	 	 
		 	Name:
		 	Title:

 [FORM OF CERTIFICATE OF AUTHENTIFICATION] 

CERTIFICATE OF AUTHENTICATION 

This is one of the Securities of the series designated herein issued under the within-mentioned Indenture. 

 

			
	U.S. BANK TRUST COMPANY, NATIONAL ASSOCIATION, as Trustee

			
		
	By:	 	 
		 	Authorized Signatory

			
		
	Dated:	 	

 REVERSE OF NOTE 

BAXTER INTERNATIONAL INC. 

Floating Rate Senior Notes due 2023 

This Note is one of a duly authorized issue of Securities of the Company of the series hereinafter specified, all issued or to be issued under
and pursuant to an Indenture, dated as of December 1, 2021, as supplemented by the First Supplemental Indenture, dated as of December 1, 2021 (both together herein called the “Indenture”), between the Company and U.S. Bank
Trust Company, National Association, as successor in interest to U.S. Bank National Association, 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 description of the rights, limitations of rights, obligations, duties and immunities thereunder of the Trustee, the Company and the Holders of the Securities. This Note is one of a
series of Securities of the Company designated as the Floating Rate Senior Notes due 2023 (the “Notes”), initially limited in aggregate principal amount of $300,000,000, subject to the issuance of additional Notes as provided in the
Indenture. Terms used but not defined herein shall have the respective meanings set forth in the Indenture. 
 The Notes will bear interest
at a rate equivalent to Compounded SOFR plus 0.260% per annum. The Notes will bear interest from December 1, 2021 or from the immediately preceding Interest Payment Date to which interest has been paid. Interest on the Notes is payable on
March 1, June 1, September 1 and December 1 of each year, beginning on March 1, 2022 (each, an “Interest Payment Date”) and on the maturity date. Interest will be payable on the Notes to the persons in whose
names such Notes are registered at the close of business on February 15, May 15, August 15 or November 15 (whether or not a Business Day), as the case may be, preceding each Interest Payment Date (each, a “Regular Record
Date”), provided, however, that interest paid on the maturity date will be payable to the person to whom the principal will be payable. Interest on the Notes will be computed on the basis of a
360-day year and the actual number of days in the Observation Period. 
 On each Interest Payment
Determination Date relating to the applicable Interest Payment Date, the Calculation Agent will calculate the amount of accrued interest payable on the Notes for each Interest Period by multiplying (i) the outstanding principal amount of the
Notes by (ii) the product of (a) the interest rate for the relevant Interest Period multiplied by (b) the quotient of the actual number of calendar days in such Observation Period divided by 360. In no event will the interest on the
Notes be less than zero. 
 “Compounded SOFR” will be determined by the Calculation Agent in accordance with the following
formula (and the resulting percentage will be rounded, if necessary, to the nearest one hundred-thousandth of a percentage point): 
  

 

 where: 

“SOFR IndexStart” equals, for periods other than the initial Interest Period, the SOFR Index value on the preceding Interest
Payment Determination Date, and, for the initial Interest Period, the SOFR Index value on December 1, 2021; 
 “SOFR
IndexEnd” equals the SOFR Index value on the Interest Payment Determination Date relating to the applicable Interest Payment Date (or in the final Interest Period, relating to the applicable maturity date); and 

“dc” is the number of calendar days in the relevant Observation Period. 

For purposes of determining Compounded SOFR, 

“Interest Payment Determination Date” means the date two U.S. Government Securities Business Days before each Interest
Payment Date. 
 “Observation Period” means, in respect of each Interest Period, the period from, and including, the date
two U.S. Government Securities Business Days preceding the first date in such Interest Period to, but excluding, the date two U.S. Government Securities Business Days preceding the Interest Payment Date for such Interest Period (or in the final
Interest Period, preceding the applicable maturity date). 
 “SOFR Index” means, with respect to any U.S. Government
Securities Business Day: 
 (1) the SOFR Index value as published by the SOFR Administrator as such index appears on the SOFR
Administrator’s Website at 3:00 p.m. (New York time) on such U.S. Government Securities Business Day (the “SOFR Index Determination Time”); provided that: 

(2) if a SOFR Index value does not so appear as specified in (1) above at the SOFR Index Determination Time, then: (i) if a Benchmark
Transition Event and its related Benchmark Replacement Date have not occurred with respect to SOFR, then Compounded SOFR shall be the rate determined pursuant to the SOFR Index Unavailable Provisions; or (ii) if a Benchmark Transition Event and
its related Benchmark Replacement Date have occurred with respect to SOFR, then Compounded SOFR shall be the rate determined pursuant to the Effect of a Benchmark Transition Event. 

“SOFR” means the daily secured overnight financing rate as provided by the SOFR Administrator on the SOFR
Administrator’s Website. 
 “SOFR Administrator” means the Federal Reserve Bank of New York (or a successor
administrator of SOFR). 
 “SOFR Administrator’s Website” means the website of the Federal Reserve Bank of New York,
currently at http://www.newyorkfed.org, or any successor source. 
 “U.S. Government Securities Business Day” means any day
except for a Saturday, a Sunday or a day on which the Securities Industry and Financial Markets Association recommends that the fixed income departments of its members be closed for the entire day for purposes of trading in U.S. government
securities. 

 If the Company or its designee determines on or prior to the relevant Reference Time that a
Benchmark Transition Event and its related Benchmark Replacement Date have occurred with respect to determining Compounded SOFR, then the benchmark replacement provisions set forth below will thereafter apply to all determinations of the rate of
interest payable on the Securities. In accordance with the benchmark replacement provisions, after a Benchmark Transition Event and its related Benchmark Replacement Date have occurred, the interest rate for each Interest Period on the Securities
will be an annual rate equal to the sum of the Benchmark Replacement and the applicable margin. 
 If a SOFR IndexStart or SOFR IndexEnd is
not published on the associated Interest Payment Determination Date and a Benchmark Transition Event and its related Benchmark Replacement Date have not occurred with respect to SOFR, “Compounded SOFR” means, for the applicable Interest
Period for which such index is not available, the rate of return on a daily compounded interest investment calculated in accordance with the formula for SOFR Averages, and definitions required for such formula, published on the SOFR
Administrator’s Website at https://www.newyorkfed.org/markets/treasury-repo-reference-rates-information. For the purposes of this provision, references in the SOFR Averages compounding formula and related definitions to “calculation
period” shall be replaced with “Observation Period” and the words “that is, 30-, 90-, or 180- calendar
days” shall be removed. If SOFR does not so appear for any day, “i” in the Observation Period, SOFRi for such day “i” shall be SOFR published in respect of the first preceding U.S. Government Securities Business Day for
which SOFR was published on the SOFR Administrator’s Website. 
 If the Company or its designee determines that a Benchmark Transition
Event and its related Benchmark Replacement Date have occurred prior to the Reference Time in respect of any determination of the Benchmark on any date, the Benchmark Replacement will replace the then-current Benchmark for all purposes relating to
the Securities in respect of such determination on such date and all determinations on all subsequent dates. In connection with the implementation of a Benchmark Replacement, the Company or its designee will have the right to make Benchmark
Replacement Conforming Changes from time to time. 
 Any determination, decision or election that may be made by the Company or its designee
pursuant to the benchmark replacement provisions described herein, including any determination with respect to 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: (i) will be conclusive and binding absent manifest error; (ii) if made by the Company, will be made in its sole discretion; (iii) if made by the
Company’s designee, will be made after consultation with the Company, and such designee will not make any such determination, decision or election to which the Company shall object; and (iv) shall become effective without consent from the
Holders of the Securities or any other party. 
 Any determination, decision or election pursuant to the benchmark replacement provisions
shall be made by the Company or its designee (which may be the Company’s affiliate but in no event shall be the initial Calculation Agent, the Trustee or the initial paying agent) on the basis as described above. None of the Calculation Agent,
the Trustee, or the initial paying agent shall have any liability or obligation whatsoever to make any such determination, decision or election. 

 The interest rate and amount of interest to be paid on the Securities for each Interest
Period will be determined by the Calculation Agent. U.S. Bank Trust Company, National Association will initially serve as the Calculation Agent. All determinations made by the Calculation Agent shall, in the absence of manifest error, be conclusive
for all purposes and binding on the Company and the Holders of the Securities. So long as Compounded SOFR is required to be determined with respect to the Securities, there will at all times be a Calculation Agent. In the event that any then acting
Calculation Agent shall be unable or unwilling to act, or that such Calculation Agent shall fail duly to establish Compounded SOFR for any Interest Period, or the Company proposes to remove such Calculation Agent, the Company shall appoint another
Calculation Agent. None of the Trustee, the paying agent and the Calculation Agent shall be under any obligation (i) to monitor, determine or verify the unavailability or cessation of SOFR or the SOFR Index, or whether or when there has
occurred, or to give notice to any other transaction party of the occurrence of, any Benchmark Transition Event or related Benchmark Replacement Date, (ii) to select, determine or designate any Benchmark Replacement, or other successor or
replacement benchmark index, or whether any conditions to the designation of such a rate or index have been satisfied, (iii) to select, determine or designate any Benchmark Replacement Adjustment, or other modifier to any replacement or
successor index, or (iv) to determine whether or what Benchmark Replacement Conforming Changes are necessary or advisable, if any, in connection with any of the foregoing. None of the Trustee, the paying agent and the Calculation Agent shall be
liable for any inability, failure or delay on its part to perform any of its duties set forth herein as a result of the unavailability of SOFR, the SOFR Index or other applicable Benchmark Replacement, including as a result of any failure,
inability, delay, error or inaccuracy on the part of any other transaction party in providing any direction, instruction, notice or information required or contemplated herein and reasonably required for the performance of such duties. 

If any Interest Payment Date, maturity date or redemption date, of this Note falls on a day that is not a Business Day, payment will be made
on the next succeeding Business Day, and no interest will accrue for the period from and after such Interest Payment Date, maturity date or redemption date, as the case may be, to the next succeeding Business Day. As used in this Note, the term
“Business Day” means each Monday, Tuesday, Wednesday, Thursday and Friday which is not a day on which banking institutions in the City of New York are authorized or obligated by or pursuant to law, regulation or executive order to
close. 
 The Indenture contains provisions for the defeasance at any time of the entire indebtedness of the Notes or certain covenants set
forth in the Indenture applicable to the Notes upon compliance by the Company of certain conditions set forth therein, which provisions apply to this Note. 

Except as set forth in the following sentence, the Notes are not subject to redemption at the option of the Company. On or after the date that
is 31 days prior to the maturity date, the Notes will be redeemable in whole at any time or in part, from time to time, at the option of the Company, at a redemption price equal to 100% of the principal amount of the notes to be redeemed, plus
accrued and unpaid interest, if any, to, but excluding, the date of redemption. 

 Any redemption made at the option of the Company (an “Optional Redemption”)
shall be made upon not less than 10 nor more than 60 days’ prior notice before the redemption date to the Holders. Any such notice of redemption may, in the Company’s discretion, be given subject to the satisfaction of one or more
conditions precedent. In that case, such notice of redemption shall describe each such condition, and such notice may be rescinded in the event that any or all such conditions shall not have been satisfied or waived by the Company by the relevant
redemption date. If the Notes are only partially redeemed by the Company pursuant to an Optional Redemption, the Notes to be redeemed shall be selected by such method as the Trustee shall deem fair and appropriate and in accordance with the
Indenture, provided, however, that in the case of Notes in global form such selection shall be made in accordance with the procedures of the applicable Depositary. In the event of redemption of this Note in part only, a new Note or Notes for
the unredeemed portion hereof shall be issued in the name of the Holder hereof upon the cancellation hereof. Unless the Company defaults in payment of the redemption price, on and after the redemption date interest will cease to accrue on the Notes
or portions thereof called for redemption. 
 If a Change of Control Triggering Event (as defined below) occurs, unless the Company has
exercised its option to redeem the Notes (as described above), the Company shall be required to make an offer (the “Change of Control Offer”) to each holder of the Notes to repurchase all or any part (equal to $2,000 or an integral
multiple of $1,000 in excess thereof) of that holder’s Notes on the terms set forth below. In the Change of Control Offer, the Company shall be required to offer payment in cash equal to 101% of the aggregate principal amount of Notes
repurchased, plus accrued and unpaid interest, if any, on the Notes repurchased to, but excluding, the date of repurchase (the “Change of Control Payment”), subject to the right of holders of record of the Notes on the relevant
Record Date to receive interest due on the relevant Interest Payment Date. Within 30 days following any Change of Control Triggering Event or, at the option of the Company, prior to any Change of Control, but after public announcement of the
transaction that constitutes or may constitute the Change of Control, a notice shall be mailed (or, with respect to Notes in global form, to the extent permitted or required by applicable Depositary procedures, sent electronically) to holders of the
Notes with a copy to the Trustee describing the transaction that constitutes or may constitute the Change of Control Triggering Event and offering to repurchase the Notes on the date specified in the notice, which date shall be no earlier than
30 days and no later than 60 days from the date such notice is mailed or sent (the “Change of Control Payment Date”). The notice shall, if mailed or sent prior to the date of consummation of the Change of Control, state
that the offer to purchase is conditioned on the Change of Control Triggering Event occurring on or prior to the Change of Control Payment Date. 

On the Change of Control Payment Date, the Company shall, to the extent lawful: 

 

	 	(1)	 accept for payment all Notes or portions of Notes properly tendered pursuant to the Change of Control Offer;

  

	 	(2)	 deposit with the paying agent an amount equal to the Change of Control Payment in respect of all Notes or
portions of Notes properly tendered; and 

  

	 	(3)	 deliver or cause to be delivered to the Trustee the Notes properly accepted together with an Officers’
Certificate stating the aggregate principal amount of Notes or portions of Notes being repurchased. 

 The Company shall not be required to make a Change of Control Offer upon the occurrence of a
Change of Control Triggering Event if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an offer made by the Company and the third party repurchases all Notes properly tendered and
not withdrawn under its offer. In addition, the Company shall not repurchase any Notes if there has occurred and is continuing on the Change of Control Payment Date an Event of Default, other than a default in the payment of the Change of Control
Payment upon a Change of Control Triggering Event. 
 The Company shall comply with the requirements of
Rule 14e-1 under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations
are applicable in connection with the repurchase of the Notes as a result of a Change of Control Triggering Event. To the extent that the provisions of any such securities laws or regulations conflict with the Change of Control Offer provisions of
the Notes, the Company shall comply with those securities laws and regulations and shall not be deemed to have breached its obligations under the Change of Control Offer provisions of the Notes by virtue of any such conflict. 

For purposes of the Change of Control Offer provisions of the Notes, the following definitions shall apply: 

“Change of Control” means the occurrence of any of the following: (1) the consummation of any transaction (including,
without limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section 13(d)(3) of the Exchange Act), other than the Company or one of its subsidiaries, becomes the beneficial owner
(as defined in Rules 13d-3 and 13d-5 under the Exchange Act), directly or indirectly, of more than 50% of the Company’s Voting Stock or other Voting Stock into
which the Company’s Voting Stock is reclassified, consolidated, exchanged or changed, measured by voting power rather than number of shares; (2) the direct or indirect sale, transfer, conveyance or other disposition (other than by way of
merger or consolidation), in one or a series of related transactions, of all or substantially all of the Company’s assets and the assets of its subsidiaries, taken as a whole, to one or more “persons” (as that term is defined in the
Indenture), other than the Company or one of its subsidiaries or (3) the adoption of a plan relating to the Company’s liquidation or dissolution. Notwithstanding the foregoing, a transaction shall not be deemed to be a Change of Control if
(1) the Company becomes a direct or indirect wholly-owned subsidiary of a holding company and (2)(A) the direct or indirect holders of the Voting Stock of such holding company immediately following that transaction are substantially the same as
the holders of the Company’s Voting Stock immediately prior to that transaction or (B) immediately following that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) (other than a holding
company satisfying the requirements of this sentence) is the beneficial owner, directly or indirectly, of more than 50% of the Voting Stock of such holding company. 

“Change of Control Triggering Event” means the occurrence of both a Change of Control and a Rating Event. 

“Investment Grade Rating” means a rating equal to or higher than Baa3 (or the equivalent) by Moody’s and BBB- (or the equivalent) by S&P, and the equivalent investment grade credit rating from any replacement Rating Agency or Rating Agencies. 

 “Moody’s” means Moody’s Investors Service, Inc. 

“Rating Agencies” means (1) each of Moody’s and S&P, and (2) if either Moody’s or S&P ceases to
rate the Notes or fails to make a rating of the Notes publicly available for reasons outside of the Company’s control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the
Exchange Act selected by the Company (as certified by a resolution of the Company’s Board of Directors) as a replacement agency for Moody’s or S&P, or both of them, as the case may be. 

“Rating Event” means the rating on the Notes is lowered by each of the Rating Agencies and the Notes are rated below an
Investment Grade Rating by each of the Rating Agencies on any day within the 60-day period (which 60-day period will be extended so long as the rating of the Notes is
under publicly announced consideration for a possible downgrade by any of the Rating Agencies but no longer than 180 days) after the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s
intention to effect a Change of Control; provided, however, that a Rating Event otherwise arising by virtue of a particular reduction in rating shall not be deemed to have occurred in respect of a particular Change of Control (and thus shall
not be deemed a Rating Event for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to which this definition would otherwise apply do not announce or publicly confirm to the
Company in writing at the Company’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of or arising as a result of, or in respect of, the applicable Change of Control (whether or not the
applicable Change of Control has occurred at the time of the Rating Event). 
 “S&P” means S&P Global Ratings, a
division of S&P Global, Inc. 
 “Voting Stock” means, with respect to any specified “person” (as that term is
used in Section 13(d)(3) of the Exchange Act), as of any date, the capital stock of such person that is at the time entitled to vote generally in the election of the board of directors of such person. 

The Company’s obligation to make a Change of Control Offer as set forth herein shall be subject to the covenant defeasance provisions of
Section 13.02(c) of the Indenture. 
 If an Event of Default, with respect to the Notes shall have occurred and be continuing, the
principal of this Note may be declared due and payable in the manner and with the effect set forth in the Indenture. 
 The Indenture
contains provisions permitting the Company and the Trustee, with the consent of the Holders of not less than a majority in aggregate principal amount of the Securities at the time Outstanding of each series to be affected to execute supplemental
indentures adding any provisions to or changing in any manner or eliminating any of the provisions of the Indenture or of any supplemental indenture or modifying in any manner the rights of the Holders of the Securities of such series subject to the
limitations set forth in the Indenture. It is also provided in the Indenture that, with respect to certain defaults or Events of Default regarding the Securities of any series, the Holders of a majority in aggregate principal amount of the
Securities at the time Outstanding of such series may on behalf of the Holders of all the Securities of such 

 
series waive any such past default or Event of Default and its consequences. The preceding sentence shall not, however, apply to a default in the payment of the principal of or premium, if any,
or interest on the Notes. Any such consent or waiver by the Holder of this Note (unless revoked as provided in the Indenture) shall be conclusive and binding upon such Holder and upon all future Holders and owners of this Note and any Notes which
may be issued in exchange or substitution herefor, irrespective of whether or not any notation thereof is made upon this Note or such other Notes. 

No reference herein to the Indenture and no provision of this Note or of the Indenture shall alter or impair the obligations of the Company,
which are absolute and unconditional, to pay the principal of, and any premium and interest on, this Note in the manner and at the respective times herein provided. 

The Notes are issuable in registered form without coupons in denominations of $2,000 and any multiple of $1,000 in excess thereof. In the
manner and subject to the limitations provided in the Indenture, but without the payment of any service charge, Notes may be exchanged for a like aggregate principal amount of Notes of other authorized denominations at the office or agency of the
Trustee in the City of New York. 
 There is no sinking fund for the retirement of the Notes. 

Upon due presentment for registration of transfer of this Note at the office or agency of the Trustee in the City of New York, a new Note or
Notes of authorized denominations for an equal aggregate principal amount will be issued to the transferee in exchange therefor, subject to the limitations provided in the Indenture, without charge except for any tax or other governmental charge
imposed in connection therewith. 
 Prior to due presentment for registration of transfer, the Company, the Trustee and any agent of the
Company, or the Trustee may treat the registered Holder hereof as the owner of this Note (whether or not this Note shall be overdue), for the purpose of receiving payment of the principal hereof and premium, if any, and subject to the provisions on
the face hereof, interest hereon, and for all other purposes, and neither the Company, nor the Trustee nor any agent of the Company, or the Trustee shall be affected by any notice to the contrary. 

No recourse under or upon any obligation, covenant or agreement contained in the Indenture or any indenture supplemental thereto or in any
Note, or because of any indebtedness evidenced thereby, shall be had against any incorporator or against any past, present or future stockholder, employee, officer or director, as such, of the Company or of any successor corporation, either directly
or through 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 and any and all such claims being expressly
waived and released as a condition of, and as a consideration for, the execution of the supplement to the Indenture and issue hereof of the Notes. 

This Note is the senior unsecured and unsubordinated obligation of the Company and will rank on parity with all other unsecured and
unsubordinated indebtedness of the Company, including any other Securities issued under the Indenture. 

 [FORM OF TRANSFER NOTICE] 

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

Insert Taxpayer Identification No. 
  

 
 Please print or typewrite name and address including
zip code of assignee 
  
  

the within Note and all rights thereunder, hereby irrevocably constituting and appointing attorney to transfer said Note on the books of 

 
  

the Company with full power of substitution in the premises. 
  

			
	By:	 	 
		
	Date:	 	 

 Schedule I 

BAXTER INTERNATIONAL INC. 

Floating Rate Senior Notes due 2023 
 No.

 The initial principal amount of this Note is $____________. 
  

							
	 Date
	  	 Principal Amount
	  	 Notation Explaining Principal

Amount Recorded
	  	 Authorized Signature of

Trustee or Custodian

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