Document:

EXHIBIT 10.4

 

NEITHER THESE SECURITIES NOR THE SECURITIES
ISSUABLE UPON CONVERSION HEREOF HAVE BEEN REGISTERED WITH THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES
COMMISSION OF ANY STATE OR UNDER THE SECURITIES ACT OF 1933, AS AMENDED. THE SECURITIES ARE RESTRICTED AND MAY NOT BE OFFERED,
RESOLD, PLEDGED OR TRANSFERRED EXCEPT AS PERMITTED UNDER THE ACT PURSUANT TO REGISTRATION REQUIREMENTS THEREOF OR EXEMPTION THEREFROM.

 

$70,000.00

 

EVENTURE INTERACTIVE, INC.

 

CONVERTIBLE DEBENTURE DUE MAY
12, 2018 

 

Date of Issuance: May 12, 2015 

 

FOR VALUE RECEIVED,
EVENTURE INTERACTIVE, INC., a corporation organized and existing under the laws of the State of Nevada (the “Company”),
hereby promises to pay to PEAK ONE OPPORTUNITY FUND, L.P., having its address at 333 South Hibiscus Drive, Miami Beach,
FL 33139, or its assigns (the “Holder” and together with the other holders of Debentures issued pursuant to the Securities
Purchase Agreement (as defined below), the “Holders”), the principal sum of Seventy Thousand and 00/100 Dollars ($70,000.00)
(the “Principal Amount”) on May 12, 2018 (the “Maturity Date”). The Company has the option to redeem
this Debenture prior to the Maturity Date pursuant to Section 2(b). All unpaid principal due and payable on the Maturity Date shall
be paid in the form of Common Stock of the Company, par value $0.001 per share (“Common Stock”) pursuant to Section
3. The Holder has the option to cause any outstanding principal and accrued interest, if any, on this Debenture to be converted
into Common Stock at any time prior to the Redemption Date (as defined below) or the Maturity Date pursuant to Section 2(a).

 

This Debenture is the
Debenture referred to in the Securities Purchase Agreement (the “Securities Purchase Agreement”) dated May 12, 2015,
between the Company and the Holder. Capitalized terms used but not defined herein shall have the meanings set forth in the Securities
Purchase Agreement. This Debenture is subject to the provisions of the Securities Purchase Agreement and further is subject to
the following additional provisions:

 

1.          This
Debenture has been issued subject to investment representations of the original purchaser hereof and may be transferred or exchanged
only in compliance with the Securities Act and other applicable state and foreign securities laws. The Holder may transfer or assign
this Debenture (or any part thereof) without the prior consent of the Company, and the Company shall cooperate with any such transfer.
In the event of any proposed transfer of this Debenture, the Company may require, prior to issuance of a new Debenture in the name
of such other Person, that it receive reasonable transfer documentation including legal opinions that the issuance of the Debenture
in such other name does not and will not cause a violation of the Securities Act or any applicable state or foreign securities
laws or is exempt from the registration requirements of the Securities Act. Prior to due presentment for transfer of this Debenture
to which the Company has consented, the Company and any agent of the Company may treat the Person in whose name this Debenture
is duly registered on the Company's books and records of outstanding debt securities and obligations (“Debenture Register”)
as the owner hereof for the purpose of receiving payment as herein provided and for all other purposes, whether or not this Debenture
be overdue, and neither the Company nor any such agent shall be affected by notice to the contrary.

 

2.          Conversion
at Holder’s Option; Redemption at Company’s Option.

 

a.   The
Holder is entitled to, at any time or from time to time, convert the Conversion Amount into shares of Common Stock, at a conversion
price for each share of Common Stock (the “Conversion Price”) equal to Sixty percent (60%) of the lowest closing bid
price (as reported by Bloomberg LP) of Common Stock for the twenty (20) trading days immediately preceding the date of conversion
of the Debentures (subject to equitable adjustments resulting from any stock splits, stock dividends, recapitalizations or similar
events). The Company shall issue irrevocable instructions to its transfer agent regarding conversions. Notwithstanding the foregoing,
the Holder shall not be entitled to convert any part of this Debenture as to which the Company has previously issued to the Holder
a Redemption Notice in accordance with Section 2(b). The Conversion Price will be adjusted as provided in Section 6. For purposes
of this Debenture, the following terms have the meanings indicated below:

 

    	 

    	 

    

 

(i)          “Conversion
Amount” shall mean the sum of (A) all or any portion of the outstanding principal amount of this Debenture, as designated
by the Holder upon exercise of its right of conversion plus (B) any interest, pursuant to Section 10 or otherwise, that has accrued
on the portion of the principal amount that has been designated for payment pursuant to (A).

 

(ii)         “Market
Price of the Common Stock” means (x) the closing bid price of the Common Stock for the period indicated in the relevant provision
hereof (unless a different relevant period is specified in the relevant provision), as reported by Bloomberg, LP or, if not so
reported, as reported on the OTCQB, OTCQX or OTC Pink or (y) if the Common Stock is listed on a stock exchange, the closing price
on such exchange, as reported by Bloomberg LP.

 

(iii)        “Trading
Day” shall mean any day on which the New York Stock Exchange is open for business.

 

Conversion shall be effectuated
by delivering by facsimile or other delivery to the Transfer Agent of the completed form of conversion notice attached hereto as
Annex A, executed by the Holder of the Debenture evidencing such Holder's intention to convert this Debenture or a specified
portion hereof. No fractional shares of Common Stock or scrip representing fractions of shares will be issued on conversion, but
the number of shares issuable shall be rounded to the nearest whole share. The date on which notice of conversion is given (the
“Conversion Date”) shall be deemed to be the date on which the Transfer Agent receives by fax or by email or by mail
the conversion notice (“Notice of Conversion”), substantially in the form annexed hereto as Annex A, duly executed,
to the Transfer Agent. Delivery of the Notice of Conversion shall be accepted by the Transfer Agent by email at yoel@vstocktransfer.com
(or such other contact email as may be designated by the Transfer Agent). Certificates representing Common Stock upon conversion
must be delivered within two (2) business days from the date of delivery of the Notice of Conversion. For the avoidance of doubt,
delivery of Common Stock issued upon conversion by DWAC shall constitute delivery for purposes hereof.

 

Notwithstanding the foregoing,
unless the Holder delivers to the Company written notice at least sixty-one (61) days prior to the effective date of such notice
that the provisions of this paragraph (the “Limitation on Ownership”) shall not apply to such Holder, in no event shall
a holder of Debentures have the right to convert Debentures into, nor shall the Company issue to such Holder, shares of Common
Stock to the extent that such conversion would result in the Holder and its affiliates together beneficially owning more than 4.99%
of the then issued and outstanding shares of Common Stock. For purposes hereof, beneficial ownership shall be determined in accordance
with Section 13(d) of the Exchange Act and Regulation 13D-G under the Exchange Act.

 

b.           So
long as no Event of Default (as defined in Section 10) shall have occurred and be continuing, the Company may at its option call
for redemption all or part of the Debentures, with the exception of any portion thereof which is the subject of a previously-delivered
Notice of Conversion, prior to the Maturity Date, as follows:

 

(i)          The
Debentures called for redemption shall be redeemable, upon not more than two (2) days written notice, for an amount (the “Redemption
Price”) equal to: (i) if the Redemption Date (as defined below) is ninety (90) days or less from the date of issuance of
this Debenture, one hundred percent (100%) of the sum of the Principal Amount so redeemed (plus accrued interest, if any); (ii)
if the Redemption Date is greater than or equal to ninety one (91) days from the date of issuance of this Debenture and less than
or equal to one hundred twenty (120) days from the date of issuance of this Debenture, One Hundred Ten percent (110%) of the sum
of the Principal Amount so redeemed (plus accrued interest, if any); (iii) if the Redemption Date is greater than or equal to one
hundred twenty one (121) days from the date of issuance of this Debenture and less than or equal to one hundred fifty (150) days
from the date of issuance of this Debenture, One Hundred Twenty percent (120%) of the sum of the Principal Amount so redeemed;
(iv) if the Redemption Date is greater than or equal to one hundred fifty one (151) days from the date of issuance of this Debenture
and less than or equal to one hundred eighty (180) days from the date of issuance of this Debenture, One Hundred Twenty Five percent
(125%) of the sum of the Principal Amount so redeemed (plus accrued interest, if any); and (v) if the Redemption Date is greater
than or equal to one hundred eighty one (181) days from the date of issuance of this Debenture, one hundred thirty percent (130%)
of the sum of the Principal Amount so redeemed (plus accrued interest, if any). The date upon which the Debentures are redeemed
and paid shall be referred to as the “Redemption Date” (and, in the case of multiple redemptions of less than the entire
outstanding Principal Amount, each such date shall be a Redemption Date with respect to the corresponding redemption).

 

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(ii)         If
fewer than all outstanding Debentures are to be redeemed and are held by different investors, then all Debentures shall be partially
redeemed on a pro rata basis.

 

(iii)        Prior
to the Redemption Date, the Company shall deposit into escrow an amount sufficient for the payment of the aggregate Redemption
Price of the Debentures being called for redemption and shall make such funds available on and after the Redemption Date for payment
to the Holders who present their Debentures and otherwise comply with the Company’s instructions contained in the Redemption
Notice (as defined below).

 

(iv)        On
the Redemption Date, the Company shall cause the Holders whose Debentures have been presented for redemption to be issued payment
of the Redemption Price. In the case of a partial redemption, the Company shall also issue new Debentures to the Holders for the
principal amount remaining outstanding after the Redemption Date promptly after the Holders’ presentation of the Debentures
called for redemption.

 

(v)         To
effect a redemption the Company shall provide a written notice to the Holder(s) not more than two (2) days prior to the Redemption
Date (the “Redemption Notice”), setting forth the following:

 

		1.	the Redemption Date;

 

		2.	the Redemption Price;

 

		3.	the aggregate principal amount of the Debentures being called for redemption;

 

		4.	a statement instructing the Holders to surrender their Debentures for
redemption and payment of the Redemption Price, including the name and address of the Company or, if applicable, the paying agent
of the Company, where Debentures are to be surrendered for redemption;

 

		5.	a statement advising the Holders that the Debentures (or,
in the case of a partial redemption, that portion of the Principal Amount being called for redemption) as of the Redemption Date
will cease to be convertible into Common Stock as of the Redemption Date; and

 

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		6.	in the case of a partial redemption, a statement advising
the Holders that after the Redemption Date a substitute Debenture will be issued by the Company after deduction the portion thereof
called for redemption, at no cost to the Holder, if the Holder so requests.

 

Notwithstanding the foregoing, in the event
the Company issues a Redemption Notice but fails to fund the redemption on the Redemption Date, then such Redemption Notice shall
be null and void, and (i) the Holder(s) shall be entitled to convert the Debentures previously the subject of the Redemption Notice,
and (ii) the Company may not redeem such Debentures for at least thirty (30) days following the intended Redemption Date that was
voided, and the Company shall be required to pay to the Holder(s) or fund into escrow the Redemption Price simultaneously with
the issuance of a Redemption Notice in connection with any subsequent redemption pursued by the Company.

 

3.          Unless
demand has otherwise been made by the Holder in writing for payment in cash as provided hereunder, and so long as no Event of Default
shall exist (whether or not notice thereof has been delivered by the Holder to the Company), any Debentures not previously tendered
to the Company for conversion as of the Maturity Date shall be deemed to have been surrendered for conversion, without further
action of any kind by the Company or any of its agents, employees or representatives, as of the Maturity Date at the Conversion
Price applicable on the Maturity Date (“Mandatory Conversion”).

 

4.          No
provision of this Debenture shall alter or impair the obligation of the Company, which is absolute and unconditional to convert
this Debenture into Common Stock, at the time, place, and rate herein prescribed. This Debenture is a direct obligation of the
Company.

 

5.          If
the Company (a) merges or consolidates with another corporation or business entity and the Company is not the surviving entity
or (b) sells or transfers all or substantially all of its assets to another Person and the holders of the Common Stock are entitled
to receive stock, securities or property in respect of or in exchange for Common Stock, then as a condition of such merger, consolidation,
sale or transfer, the Company and any such successor, purchaser or transferee will agree that this Debenture may thereafter be
converted on the terms and subject to the conditions set forth above into the kind and amount of stock, securities or property
receivable upon such merger, consolidation, sale or transfer by a holder of the number of shares of Common Stock into which this
Debenture might have been converted immediately before such merger, consolidation, sale or transfer, subject to adjustments which
shall be as nearly equivalent as may be practicable. In the event of any (i) proposed merger or consolidation where the Company
is not the surviving entity or (ii) sale or transfer of all or substantially all of the assets of the Company (in either such case,
a “Sale”), the Holder shall have the right to convert by delivering a Notice of Conversion to the Company within fifteen
(15) days of receipt of notice of such Sale from the Company.

 

6.          If,
at any time while any portion of this Debenture remains outstanding, the Company effectuates a stock split or reverse stock split
of its Common Stock or issues a dividend on its Common Stock consisting of shares of Common Stock or otherwise recapitalizes its
Common Stock, the Conversion Price shall be equitably adjusted to reflect such action. By way of illustration, and not in limitation,
of the foregoing (i) if the Company effectuates a 2:1 split of its Common Stock, thereafter, with respect to any conversion for
which the Company issues the shares after the record date of such split, the Conversion Price shall be deemed to be one-half of
what it had been calculated to be immediately prior to such split; (ii) if the Company effectuates a 1:10 reverse split of its
Common Stock, thereafter, with respect to any conversion for which the Company issues the shares after the record date of such
reverse split, the Conversion Price shall be deemed to be the amount of such Conversion Price calculated immediately prior to the
record date multiplied by 10; and (iii) if the Company declares a stock dividend of one share of Common Stock for every 10 shares
outstanding, thereafter, with respect to any conversion for which the Company issues the shares after the record date of such dividend,
the Conversion Price shall be deemed to be the amount of such Conversion Price calculated immediately prior to such record date
multiplied by a fraction, of which the numerator is the number of shares for which a dividend share will be issued and the denominator
is such number of shares plus the dividend share(s) issuable or issued thereon.

 

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7.          All
payments contemplated hereby to be made “in cash” shall be made by wire transfer of immediately available funds 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. All payments of cash and each delivery of shares of Common Stock issuable to the Holder as contemplated hereby shall be
made to the Holder to an account designated by the Holder to the Company and if the Holder has not designated any such accounts
at the address last appearing on the Debenture Register of the Company as designated in writing by the Holder from time to time;
except that the Holder may designate, by notice to the Company, a different delivery address for any one or more specific payments
or deliveries.

 

8.          The
Holder of the Debenture, by acceptance hereof, agrees that this Debenture is being acquired for investment and that such Holder
will not offer, sell or otherwise dispose of this Debenture or the Shares of Common Stock issuable upon conversion thereof except
in compliance with the terms of the Securities Purchase Agreement and under circumstances which will not result in a violation
of the Securities Act or any applicable state Blue Sky or foreign laws or similar laws relating to the sale of securities.

 

9.          This
Debenture shall be governed by and construed in accordance with the laws of the State of Nevada. Each of the parties consents to
the exclusive jurisdiction and venue of the state and/or federal courts located in Miami-Dade County,
Florida in connection with any dispute arising under this Agreement. This provision is intended
to be a “mandatory” forum selection clause and governed by and interpreted consistent with Florida law. Each of the
parties hereby consents to the exclusive jurisdiction and venue of any state or federal court having its situs in said county,
and each waives any objection based on forum non conveniens. To the extent determined by such court, the Company shall reimburse
the Holder for any reasonable legal fees and disbursements incurred by the Holder in enforcement of or protection of any of its
rights under this Debenture or the Securities Purchase Agreement.

 

10.         The
following shall constitute an “Event of Default”:

 

a.     The
Company fails in the payment of principal or interest (to the extent that interest is imposed under this Section 10) on this Debenture
as required to be paid in cash hereunder, and payment shall not have been made for a period of five (5) business days following
the payment due date; or

 

b.     Any
of the representations or warranties made by the Company herein, in the Securities Purchase Agreement between the Company and the
Buyer therein, or in any certificate or financial or other written statements heretofore or hereafter furnished by the Company
to in connection with the execution and delivery of this Debenture, the Securities Purchase Agreement shall be false or misleading
(including without limitation by way of the misstatement of a material fact or the omission of a material fact) in any material
respect at the time made (as to which no cure period shall apply); or

 

c.     The
Company fails to remain listed on OTCQB or a more senior stock exchange any time from the date hereof to the Maturity Date for
a period in excess of five (5) trading days.

 

d.      The
Company (i) fails to timely file required SEC reports when due, becomes, is deemed to be or asserts that it is a “shell company”
at any time for purposes of the 1933 Act, and Rule 144 promulgated thereunder or otherwise takes any action, or refrains from taking
any action, the result of which makes Rule 144 under the 1933 unavailable to the Buyer for the sale of their Securities, (ii) fails
to issue shares of Common Stock to the Holder or to cause its Transfer Agent to issue shares of Common Stock upon exercise by the
Holder of the conversion rights of the Holder in accordance with the terms of this Debenture, (iii) fails to transfer or to cause
its Transfer Agent to transfer any certificate for shares of Common Stock issued to the Holder upon conversion of this Debenture
as and when required by this Debenture and such transfer is otherwise lawful or (iv) fails to remove any restrictive legend or
to cause its Transfer Agent to transfer any certificate or any shares of Common Stock issued to the Holder upon conversion of this
Debenture as and when required by this Debenture and such legend removal is otherwise lawful (no cure period shall apply in the
case of clauses (i) through (iv) above, inclusive); or

 

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e.      The
Company shall fail to perform or observe, in any material respect (i) any other covenant, term, provision, condition, agreement
or obligation of the Debenture, provided that, other than in the case of such failure under Section 5 hereof, as to which no cure
period shall apply, such failure shall continue uncured for a period of thirty (30) days after written notice from the holder of
such failure, or (ii) any covenant, term, provision, condition, agreement or obligation of the Company under the Securities Purchase
Agreement and such failure shall continue uncured for a period of either (a) three (3) days after the occurrence of the Company’s
failure under Section 4(d), (e) (except as described in Section 10(c) hereof, as to which Section 10(c) hereof shall control),
(f), (g) or (h) of the Securities Purchase Agreement, or (b) thirty (30) days after the occurrence of the Company’s failure
under any other provision of the Securities Purchase Agreement; or

 

f.      The
Company shall (1) admit in writing its inability to pay its debts generally as they mature; (2) make an assignment for the benefit
of creditors or commence proceedings for its dissolution; or (3) apply for or consent to the appointment of a trustee, liquidator
or receiver for its or for a substantial part of its property or business; or

 

g.     A
trustee, liquidator or receiver shall be appointed for the Company or for a substantial part of its property or business without
its consent and shall not be discharged within sixty (60) days after such appointment; or

 

h.     Any
governmental agency or any court of competent jurisdiction at the instance of any governmental agency shall assume custody or control
of the whole or any substantial portion of the properties or assets of the Company and shall not be dismissed within sixty (60)
days thereafter; or

 

i.      Any
money judgment, writ or warrant of attachment, or similar process (including an arbitral determination), in excess of Fifty Thousand
Dollars ($50,000) in the aggregate shall be entered or filed against the Company or any of its properties or other assets; or

 

j.      The
occurrence of an event of default under the terms of any indebtedness of the Company or any subsidiary (including but not limited
to any Subsidiary) of the Company in the aggregate amount of $50,000 or more which is not waived by the creditors under such indebtedness
(as to which no cure period shall apply); or

 

k.     Bankruptcy,
reorganization, insolvency or liquidation proceedings or other proceedings for relief under any bankruptcy law or any law for the
relief of debtors shall be instituted by or against the Company and, if instituted against the Company, shall not be dismissed
within sixty (60) days after such institution or the Company shall by any action or answer approve of, consent to, or acquiesce
in any such proceedings or admit the material allegations of, or default in answering a petition filed in any such proceeding;
or

 

l.      The
issuance of an order, ruling, finding or similar adverse determination by the Securities and Exchange Commission, the Secretary
of State of the State of Nevada, the National Association of Securities Dealers, Inc. or any other securities regulatory body (whether
in the United States, Canada or elsewhere) having proper jurisdiction that the Company and/or any of its past or present directors
or officers have committed a material violation of applicable securities laws or regulations; or

 

m.    The
Company shall have its Common Stock suspended or delisted from a national securities exchange or an electronic quotation service
such as the OTCQB, OTCQX for a period in excess of five (5) trading days;

 

n.    Any
of the following shall occur and be continuing: (i) a breach or default under (a) any agreement identified by the Company in its
SEC Filings as a material agreement or (b) any note or other form of indebtedness in favor of the Company (collectively, the “Material
Agreements”), irrespective of whether such breach or default was waived, and (ii) any other event, circumstance or combination
thereof shall have occurred which, singly or when taken as a whole, results in a Material Adverse Effect;

 

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o.     The
determination in good faith by the Holder that a material adverse change has occurred in the financial condition or operations
of the Company or any of its subsidiaries which change could have a Material Adverse Effect on the prospect for the Company to
fully and punctually realize the full benefits conferred on the Holder by this Agreement, or the prospect of repayment of all Obligations.

 

p.     The
determination in good faith by Holder that the prospect for payment or performance of any of the Obligations is impaired for any
reason.

 

Then, or at any time
thereafter, the Company shall immediately give written notice of the occurrence of such Event of Default to the Holders of all
Debentures then outstanding, and in each and every such case, unless such Event of Default shall have been waived in writing by
a majority in interest of the Holders of the Debentures (which waiver shall not be deemed to be a waiver of any subsequent default),
then at the option of a majority in interest of the Holders and in the discretion of a majority in interest of the Holders, (i)
pursue remedies against the Company in accordance with the Holder’s rights in the Collateral, (ii) the interest rate applicable
to the Debentures shall be increased to the lesser of eighteen percent (18%) per annum and the maximum interest rate allowable
under applicable law, and (iii) the Holder may at its option and discretion declare this Debenture, together with all accrued and
unpaid interest thereon, in an amount equal to one hundred forty percent (140%) of the Principal Amount plus accrued and unpaid
interest (the “Acceleration Amount”), to be immediately due and payable, without presentment, demand, protest or notice
of any kinds, all of which are hereby expressly waived, anything herein or in any note or other instruments contained to the contrary
notwithstanding. At its option, a Holder may elect to convert the Debenture pursuant to Section 2 notwithstanding the prior declaration
of a default and acceleration, in the sole discretion of such Holder. A majority in interest of the Holders may immediately enforce
any and all of the Holder's rights and remedies provided herein or any other rights or remedies afforded by law. Notwithstanding
the foregoing, in the case of a default under Section 10(c), the Holder of the Debenture sought to be converted, transferred or
de-legended, as the case may be, acting singly, shall have the sole and absolute discretion to increase the applicable interest
rate on the Debentures held by such Holder and/or to declare the Debenture(s) held by such Holder to be immediately due and payable.
The Company expressly acknowledges and agrees that the Acceleration Amount as so increased in the event of a default is reasonable
and appropriate due to the inability to define the financial hardship that the Company’s default would impose on the Holders.

 

11.         Nothing
contained in this Debenture shall be construed as conferring upon the Holder the right to vote or to receive dividends or to consent
or receive notice as a shareholder in respect of any meeting of shareholders or any rights whatsoever as a shareholder of the Company,
unless and to the extent converted in accordance with the terms hereof.

 

12.         This
Debenture may be amended only by the written consent of the parties hereto. Notwithstanding the foregoing, the principal amount
of this Debenture shall automatically be reduced by any and all Conversion Amounts (to the extent that the same relate to principal
hereof). In the absence of manifest error, the outstanding principal amount of the Debenture on the Company’s book and records
shall be the correct amount.

 

13.         No
waivers or consents in regard to any provision of this Debenture may be given other than by an instrument in writing signed by
the Holder.

 

[Signature Page Follows]

 

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IN WITNESS WHEREOF, the Company
has caused this Debenture to be duly executed by an officer thereunto duly authorized as of the date of issuance set forth above.

 

	 	EVENTURE INTERACTIVE, INC.
	 	 	 
	 	By:	/s/ Gannon Giguiere
	 	Name:	Gannon Giguiere
	 	Title:	President, Secretary and Chairman of the Board of Directors

 

    	8Form of Medium-Term Notes, Series K, Notes

 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. 94986RXC0 
	
PRINCIPAL AMOUNT: $                   
          

 REGISTERED NO.      

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Notes Linked to 3 Month LIBOR due May 18, 2020 

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, the principal sum of
                                                        
                                                     
   DOLLARS ($                    ) on May 18, 2020 (the “Stated Maturity Date”) and to pay interest
thereon from May 18, 2015 or from the most recent Interest Payment Date to which interest has been paid or duly provided for quarterly on each February 18, May 18, August 18 and November 18, commencing August 18, 2015
and at Maturity (each, an “Interest Payment Date”), at the rate per annum specified below until the principal hereof is paid or made available for payment. The interest so payable, and punctually paid or duly provided for, on any
Interest Payment Date will, as provided in the Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest next preceding
such Interest Payment Date. The Regular Record Date for an Interest Payment Date shall be one Business Day prior to such Interest Payment Date. If an Interest Payment Date is not a Business Day, interest on this Security shall be payable on the next
day that is a Business Day, with the same force and effect as if made on such Interest Payment Date, and without any interest or other payment with respect to the delay. “Business Day” shall mean a day, other than a Saturday or
Sunday, (i) that is neither a legal holiday nor a day on which banking institutions are authorized or required by law or regulation to close in New York, New York and (ii) that is also a London Banking Day (as defined below). 

Except as described below for the first Interest Period, on each Interest Payment Date, interest will be paid for the period
commencing on and including the immediately preceding 

 
Interest Payment Date and ending on and including the day immediately preceding that Interest Payment Date. This period is referred to as an “Interest Period.” The first Interest
Period will commence on and include May 18, 2015 and end on and include August 17, 2015. Interest on this Security will be computed on the basis of a 360-day year of twelve 30-day months. 
 The interest rate on this Security that will apply during the first
twelve Interest Periods (up to and including the Interest Period ending May 17, 2018) will be equal to 1.88% per annum. For all Interest Periods commencing on or after May 18, 2018, the interest rate on this Security will be
determined by the calculation agent for this Security (the “Calculation Agent”) and will be equal to 3 month LIBOR on the Determination Date for such Interest Period plus 1.00%, but in no event will such rate be more than the
Maximum Interest Rate. 
 The “Determination Date” for an Interest Period commencing on or after
May 18, 2018 will be two London Banking Days prior to the first day of such Interest Period. A “London Banking Day” is any day on which commercial banks and foreign exchange markets settle payments in London. 

“3 month LIBOR” means, for any Determination Date, the arithmetic mean of the offered rates for deposits
in U.S. dollars having a 3 month maturity, commencing on the second London Banking Day immediately following that Determination Date that appear on the Designated LIBOR Page as of 11:00 a.m., London time, on that Determination Date, if at
least two offered rates appear on the Designated LIBOR Page, provided that if the Designated LIBOR Page by its terms provides only for a single rate, that single rate will be used. The “Designated LIBOR Page” means the display on
Reuters, or any successor service, on page LIBOR01, or any other page as may replace that page on that service, for the purpose of displaying the London Interbank rates for U.S. dollars. 

If (i) fewer than two offered rates appear or (ii) no rate appears and the Designated LIBOR Page by its terms
provides only for a single rate, then the Calculation Agent will request the principal London offices of each of four major banks in the London Interbank market, as selected by the Calculation Agent, to provide the Calculation Agent with its offered
quotation for deposits in U.S. dollars for a 3 month period commencing on the second London Banking Day immediately following that Determination Date to prime banks in the London Interbank market at approximately 11:00 a.m., London time,
on that Determination Date and in a principal amount that is representative of a single transaction in U.S. dollars in that market at that time. If at least two quotations are provided, 3 month LIBOR determined on that Determination Date will
be the arithmetic mean of those quotations. 
 If fewer than two quotations are provided, 3 month LIBOR will be the
arithmetic mean of the rates quoted at approximately 11:00 a.m. in New York, New York on that Determination Date by three major banks in New York, New York selected by the Calculation Agent for loans in U.S. dollars to leading European banks,
having a 3 month maturity and in a principal amount that is representative of a single transaction in U.S. dollars in that market at that time. 

  
 2 

 If the banks so selected by the Calculation Agent are not quoting as set forth
above, 3 month LIBOR for that Determination Date will remain 3 Month LIBOR for the immediately preceding Interest Period or, if none, the interest rate will be 1.88% per annum. 

The “Maximum Interest Rate” applicable to an Interest Period commencing on or after May 18, 2018 is
2.75% per annum. 
 The Calculation Agent shall, upon the request of a Holder of this Security, provide the interest
rate then in effect and, if determined, the interest rate that will become effective for the next Interest Period. All calculations of the Calculation Agent, in the absence of manifest error, shall be conclusive for all purposes and binding on the
Company and the Holder hereof. The Calculation Agent shall notify the Paying Agent of each determination of the interest applicable to this Security promptly after the determination is made. Wells Fargo Securities, LLC will initially act as
Calculation Agent. The Company may appoint a successor Calculation Agent with the written consent of the Trustee. 
 Any
interest not punctually paid or duly provided for will forthwith cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at
the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof shall be given to Holders of Securities of this series not less than 10 days prior to such Special Record Date,
or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be required by such exchange, all as more fully
provided in the Indenture. 
 Payment of interest on this Security will be made in immediately available funds at the office
or agency of the Company maintained for that purpose in the City of Minneapolis, Minnesota 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; provided, however,
that, at the option of the Company, payment of interest may be paid by check mailed to the Person entitled thereto at such Person’s last address as it appears in the Security Register or by wire transfer to such account as may have been
designated by such Person. Payment of principal of and interest 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.
Notwithstanding the foregoing, for so long as this Security is a Global Security registered in the name of the Depositary, payments of principal and interest on this Security will be made to the Depositary by wire transfer of immediately available
funds. 
 This Security is not subject to redemption at the option of the Company or repayment at the option of the Holder
hereof prior to May 18, 2020. This Security is not entitled to any sinking fund. 
  

 

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. 

  
 3 

 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 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] 

  
 4 

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

 

					
	WELLS FARGO & COMPANY
		
	By:		 
			Paul R. Ackerman
			Its:		Executive Vice President and Treasurer

 [SEAL] 
  

					
	Attest:		 
			Jeannine E. Zahn
			Its:		Assistant 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

  
 5 

 [Reverse of Note] 

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 

Due Nine Months or More From Date of Issue 

Notes Linked to 3 Month LIBOR due May 18, 2020 

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 of the Securities designated as Medium-Term Notes, Series K, of the Company, which series is limited to an aggregate principal amount or face amount, as applicable, of $25,000,000,000 or the equivalent thereof in one or more
foreign or composite currencies. The amount payable on the Securities of this series may be determined by reference to the performance of one or more equity-, commodity- or currency-based indices, exchange traded funds, securities, commodities,
currencies, statistical measures of economic or financial performance, or a basket comprised of two or more of the foregoing, or any other market measure or may bear interest at a fixed rate or a floating rate. The Securities of this series may
mature at different times, be redeemable at different times or not at all, be repayable at the option of the Holder at different times or not at all and be denominated in different currencies. 

Article Sixteen of the Indenture shall not apply to this Security. 

The Securities are issuable only in registered form without coupons and will be either
(a) book-entry securities represented by one or more Global Securities recorded in the book-entry system maintained by the Depositary or (b) certificated
securities issued to and registered in the names of, the beneficial owners or their nominees. 
 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 this Security. 

Modification and Waivers 

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 as a class. The Indenture also contains 

  
 6 

 
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 as a
class, 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. 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.

 Defeasance 

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. 
 Authorized
Denominations 
 This Security is issuable only in registered form without coupons in denominations of $1,000 or any
amount in excess thereof which is an integral multiple of $1,000. 
 Registration of Transfer 

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, with the same terms as this Security, 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, bearing interest at the same rate, having the same date of issuance, Stated Maturity Date and other 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 

  
 7 

 
of such successor. Except as provided above, owners of beneficial interests in this Global 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. 
 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. 
 Obligation of the Company Absolute 

No reference herein to the Indenture and no provision of this Security or the Indenture shall alter or impair the obligation
of the Company, which is absolute and unconditional, to pay the principal of and interest on this Security at the times, place and rate, and in the coin or currency, herein prescribed, except as otherwise provided in this Security. 

No Personal Recourse 

No recourse shall be had for the payment of the principal of or the interest on this Security, or for any claim based hereon,
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. 
 Defined Terms 

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. 
 Governing Law 

This Security shall be governed by and construed in accordance with the law of the State of New York, without regard to
principles of conflicts of laws. 

  
 8 

 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)

  
 9 

 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. 

  
 10

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