Document:

EX-4.1

 Exhibit 4.1 

[Form of 4.25% Subordinated Notes due 2025] 
  

			
	Registered No.	 	CUSIP No. 38141GVR2
		 	ISIN No. US38141GVR28

 (Face of Security) 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE INDENTURE AS DEFINED HEREIN ON THE REVERSE OF THIS SECURITY AND IS REGISTERED
IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE EXCHANGED IN WHOLE OR IN PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SECURITY IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH
DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. 
 UNLESS THIS CERTIFICATE IS
PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), TO THE GOLDMAN SACHS GROUP, INC. OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS
REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF
DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. 

THIS SECURITY IS NOT A BANK DEPOSIT AND IS NOT INSURED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION OR ANY OTHER GOVERNMENTAL AGENCY, NOR
IS IT AN OBLIGATION OF, OR GUARANTEED BY, A BANK. 
 (Face of Security continued on next page) 

 THE GOLDMAN SACHS GROUP, INC. 

4.25% Subordinated Notes due 2025 

The Goldman Sachs Group, Inc., a corporation duly organized and existing under the laws of the State of Delaware (herein called the
“Company”, which term includes any successor Person under the Indenture as defined on the reverse of this Security), for value received, hereby promises to pay
to                                 , or registered assigns, the principal sum of
                 on October 21, 2025 and to pay interest thereon, calculated as set forth below, on April 21 and October 21 in each year, commencing
on April 21, 2016, and at the Maturity of the principal hereof, at the rate of 4.25% per annum, until the principal hereof is paid or made available for payment. Any such installment of interest that is overdue shall also bear interest at
the rate of 4.25% per annum (to the extent that the payment of such interest shall be legally enforceable), from the date any such overdue amount first becomes due until it is paid or made available for payment. Notwithstanding the foregoing,
interest on any installment of interest that is overdue shall be payable on demand. 
 On each Interest Payment Date or at the
Maturity of the principal hereof, the amount of interest payable will equal the principal sum hereof multiplied by an accrued interest factor for the Interest Period. The Interest Period will be the period from and including October 21,
2015, or the last date to which interest has been paid or made available for payment, to but excluding such Interest Payment Date or Maturity, as the case may be (subject to “Payments Due on a Business Day” below). The accrued interest
factor will be determined by multiplying the annual interest rate times the actual number of days in the Interest Period, divided by 360, to be calculated as follows:  

[360×(Y2–Y1 )]+[30×(M2–M1)]+(D2–D1) 

360 
 where: 

“Y1” is the year, expressed as a number, in which the first day of the interest period falls; 

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

 “M1” is the calendar month, expressed as a number, in which the first day of the interest period falls; 

“M2” is the calendar month, expressed as a number, in which the day immediately following the last day included in the interest
period falls; 
 “D1” is the first calendar day, expressed as a number, of the interest period, unless such number would be 31, in
which case D1 will be 30; and 

  
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 -2- 

 “D2” is the calendar day, expressed as a number, immediately following the last day
included in the interest period, unless such number would be 31 and D1 is greater than 29, in which case D2 will be 30. 
 The interest so
payable, and punctually paid or made available for payment, on any Interest Payment Date will, as provided in the Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of
business on the Regular Record Date for such interest, which shall be the calendar day (whether or not a Business Day, as defined below) next preceding such Interest Payment Date (or, if such interest is to be paid on another day as provided below,
next preceding such other day). Any interest so payable, but not punctually paid or made available for payment, on any Interest Payment Date will forthwith cease to be payable to the Holder on such Regular Record Date and such Defaulted Interest may
either be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof
being given to the Holder of this Security not less than 10 days prior to such Special Record Date, or be paid in any other lawful manner not inconsistent with the requirements of any securities exchange on which this Security may be listed, and
upon such notice as may be required by such exchange, all as more fully provided in the Indenture. 
 All percentages resulting from any
calculation with respect to this Security will be rounded upward or downward, as appropriate, to the next higher or lower one hundred-thousandth of a percentage point (e.g., 9.876541% (or .09876541) being rounded down to 9.87654% (or
..0987654) and 9.876545% (or .09876545) being rounded up to 9.87655% (or .0987655)). All amounts used in or resulting from any calculation with respect to this Security will be rounded upward or downward, as appropriate, to the nearest cent, in the
case of U.S. dollars, or to the nearest corresponding hundredth of a unit, in the case of a currency other than U.S. dollars, with one-half cent or one-half of a corresponding hundredth of a unit or more being rounded upward. 

Currency and Manner of Payment 

Payment of the principal of and premium or interest on this Security will be made 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. Notwithstanding any other provision of this Security or the Indenture, if this Security is a Global Security, any payment in respect of this Security may be made
pursuant to the Applicable Procedures of the Depositary as permitted in the Indenture. 
 Subject to the prior paragraph and except as
provided in the next paragraph, payment of any amount payable on this Security will be made at the office or agency of the Company maintained for that purpose in The City of New York (and at any other office or agency maintained by the Company for
that purpose), against surrender of this Security in the case of any payment due at the Maturity of the principal hereof (other than any payment of interest that first becomes due on an Interest Payment Date); provided, however, that,
at the option of the Company and subject to the next paragraph, payment of interest may be made by check mailed to the address of the Person entitled thereto as such address shall appear in the Security Register. 

  
 (Face of Security
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 -3- 

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

Payments Due on a Business Day 

Notwithstanding any provision of this Security or the Indenture, if the Maturity of the principal hereof occurs on a day that is not a Business
Day, any amount of principal, premium or interest that would otherwise be due on this Security on such day (the “Specified Day”) may be paid or made available for payment on the Business Day that is next succeeding the Specified Day
with the same force and effect as if such amount were paid on the Specified Day, and no interest will accrue on the amount so payable for the period from the Specified Day to such next succeeding Business Day. “Business Day” means any day
that is not a Saturday or Sunday, and that is not a day on which banking institutions generally are authorized or obligated by law, regulation or executive order to close in The City of New York. 

If any Interest Payment Date other than one that falls on the date of Maturity of the principal hereof would otherwise fall on a day that is
not a Business Day, any payment due on such date shall be postponed to the next day that is a Business Day; provided that interest due with respect to an Interest Payment Date shall not accrue from and including such Interest Payment Date to
and including the date of payment of such interest as so postponed; provided further that the Interest Periods shall not be adjusted for non-Business Days. 

The provisions of the two immediately preceding paragraphs shall apply to this Security in lieu of the provisions of Section 113 of the
Indenture. 

  
 (Face of Security
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 -4- 

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

  
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 -5- 

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

Dated: 
  

			
	THE GOLDMAN SACHS GROUP, INC.
	By	 	   

		 	Name:
		 	Title:

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

Dated: 
  

			
	THE BANK OF NEW YORK MELLON,
		 	as Trustee
	By	 	   

		 	Authorized Signatory

  
 -6- 

 (Reverse of Security) 

1. Securities and Indenture. 

This Security is one of a duly authorized issue of securities of the Company (herein called the “Securities”) issued and to be issued
in one or more series under a Subordinated Debt Indenture, dated as of February 20, 2004, as amended and supplemented prior to the date hereof (herein called the “Indenture”, which term shall have the meaning assigned to it in such
instrument), between the Company and The Bank of New York Mellon (formerly known as The Bank of New York), as Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), and reference is hereby
made to the Indenture for a statement of the respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee, the holders of Senior Debt and the Holders of the Securities and of the terms upon which the
Securities are, and are to be, authenticated and delivered. 
 2. Series and Denominations. 

This Security is one of the series designated on the face hereof, limited to an aggregate principal amount as shall be determined and may be
increased from time to time by the Company. Any election by the Company so to increase such aggregate principal amount shall be evidenced by a certificate of an Authorized Person (as defined in the Determination of an Authorized Person,
dated October 21, 2015, with respect to this series). References herein to “this series” mean the series of Securities designated on the face hereof. The Securities of this series are issuable only in registered form without coupons
in denominations of integral multiples of $1,000, subject to a minimum denomination of $2,000. 
 3. Additional
Amounts. 
 If the beneficial owner of this Security is a United States Alien (as defined below), the Company will pay all additional
amounts that may be necessary so that every net payment of the principal of and interest on this Security to such beneficial owner, after deduction or withholding for or on account of any present or future tax, assessment or governmental charge
imposed with respect to such payment by any U.S. Taxing Authority (as defined below), will not be less than the amount provided for in this Security to be then due and payable; provided, however, that the Company shall have no
obligation to pay additional amounts for or on account of any one or more of the following: 
 (i) any tax, assessment or
other governmental charge imposed solely because at any time there is or was a connection between such beneficial owner (or between a fiduciary, settlor, beneficiary or member of such beneficial owner, if such beneficial owner is an estate, trust or
partnership) and the United States (as defined below) (other than the mere receipt of a payment on, or the ownership or holding of, a Security), including because such beneficial owner (or such fiduciary, settlor, beneficiary or member) at any time,
for U.S. federal income tax purposes: (a) is or was a citizen or resident, or is or was treated as a resident, of the United States, (b) is or was present in the 

  
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United States, (c) is or was engaged in a trade or business in the United States, (d) has or had a permanent establishment in the United States, (e) is or was a domestic or foreign
personal holding company, a passive foreign investment company or a controlled foreign corporation, (f) is or was a corporation that accumulates earnings to avoid U.S. federal income tax or (g) is or was a “10-percent
shareholder” of the Company as defined in section 871(h)(3) of the U.S. Internal Revenue Code or any successor provision; 

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

(iii) any estate, inheritance, gift, sales, excise, transfer, wealth or personal property tax or any similar tax, assessment or
other governmental charge; 
 (iv) any tax, assessment or other governmental charge imposed solely because such beneficial
owner or any other Person fails to comply with any certification, identification or other reporting requirement concerning the nationality, residence, identity or connection with the United States of the Holder or any beneficial owner of this
Security, if compliance is required by statute, by regulation of the U.S. Treasury Department or by an applicable income tax treaty to which the United States is a party, as a precondition to exemption from such tax, assessment or other governmental
charge; 
 (v) any tax, assessment or other governmental charge that is payable otherwise than by deduction or withholding
from payments of principal of or interest on this Security; 
 (vi) any tax, assessment or other governmental charge imposed
solely because the payment is to be made by a particular Paying Agent (which term may include the Company) and would not be imposed if made by another Paying Agent (which term may include the Company); 

(vii) any tax, assessment or other governmental charge imposed solely because the Holder (1) is a bank purchasing this
Security in the ordinary course of its lending business or (2) is a bank that is neither (A) buying this Security for investment purposes only nor (B) buying this Security for resale to a third party that either is not a bank or
holding the note for investment purposes only; or 
 (viii) any combination of the taxes, assessments or other governmental
charges described in items (i) through (vii) of this Section 3. 
 Additional amounts also will not be paid with respect to
any payment of principal of or interest on this Security to any United States Alien who is a fiduciary or a partnership, or who is not the sole beneficial owner of any such payment, to the extent that the Company would not be required to pay
additional amounts to any beneficiary or settlor of such fiduciary or any member of such a partnership, or to any beneficial owner of the payment, if that Person had been treated as the beneficial owner of this Security for this purpose. 

  
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 -8- 

 In addition, any amounts to be paid on this Security will be paid net of any deduction or
withholding imposed or required pursuant to Sections 1471 through 1474 of the U.S. Internal Revenue Code, any current or future regulations or official interpretations thereof, any agreement entered into pursuant to Section 1471(b) of the Code,
or any fiscal or regulatory legislation, rules or practices adopted pursuant to any intergovernmental agreement entered into in connection with the implementation of such Sections of the U.S. Internal Revenue Code, and no additional amounts will be
required to be paid on account of any such deduction or withholding. 
 The term “United States Alien” means any Person
who, for U.S. federal income tax purposes, is a nonresident alien individual, a foreign corporation, a foreign partnership one or more of the members of which is, for United States federal income tax purposes, a foreign corporation, a nonresident
alien individual or a nonresident alien fiduciary of a foreign estate or trust, or a nonresident alien fiduciary of an estate or trust that is not subject to U.S. federal income tax on a net income basis on income or gain from this Security. For the
purposes of this Section 3 and Section 4 only, (a) the term “United States” means the United States of America (including the states thereof and the District of Columbia), together with the territories, possessions
and all other areas subject to the jurisdiction of the United States of America and (b) the term “U.S. Taxing Authority” means the United States of America or any state, other jurisdiction or taxing authority in the United
States. 
 Except as specifically provided in this Security, the Company shall not be required to make any payment with respect to any tax,
assessment or other governmental charge imposed by any government or any political subdivision or taxing authority thereof or therein. 

Whenever in the Securities of this series (or in the Indenture) there is a reference, in any context, to the payment of the principal of or
interest on any Security of this series, such mention shall be deemed to include mention of any payment of additional amounts to United States Aliens in respect of such payment of principal or interest to the extent that, in such context, such
additional amounts are, were or would be payable in respect thereof pursuant to this Section 3 or any corresponding section of another Security of this series, as the case may be. Express mention of the payment of additional amounts in any
provision of any Security of this series shall not be construed as excluding additional amounts in the provisions of any Security of this series (or of the Indenture insofar as it applies to this series) where such express mention is not made. 

4. Redemption at the Company’s Option. 

The Securities of this series may be redeemed, as a whole but not in part, at the option of the Company, at a redemption price equal to 100% of
the principal amount of the Securities to be redeemed, together with interest accrued to the date fixed for redemption, if, as a result of any amendment to, or change in, the laws or regulations of any U.S. Taxing Authority (as defined in
Section 3 above), or any amendment to or change in any official interpretation or application of such laws or regulations, which amendment or change becomes effective or is announced on or after October 16, 2015, the Company will become
obligated to pay, on the next Interest Payment 

  
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 -9- 

 
Date, additional amounts in respect of any Security of this series pursuant to Section 3 of this Security or any corresponding section of another Security of this series. If the Company
becomes entitled to redeem the Securities of this series, it may do so on any day thereafter pursuant to the Indenture; provided, however, that (1) the Company gives the Holder of this Security notice of such redemption not more
than 60 days nor less than 30 days prior to the date fixed for redemption as provided in the Indenture, (2) no such notice of redemption may be given earlier than 90 days prior to the next Interest Payment Date on which the Company would
be obligated to pay such additional amounts and (3) at the time such notice is given, such obligation to pay such additional amounts remains in effect. Immediately prior to the giving of any notice of redemption of Securities pursuant to this
Section 4, the Company will deliver to the Trustee an Officers’ Certificate stating that the Company is entitled to effect such redemption and setting forth in reasonable detail a statement of facts showing that the conditions precedent to
the right of the Company to so redeem the Securities have occurred. Interest installments due on or prior to a Redemption Date will be payable to the Holder of this Security or one or more Predecessor Securities, of record at the close of business
on the relevant record date, all as provided in the Indenture. 
 5. Subordination. 

The indebtedness evidenced by this Security is, to the extent provided in the Indenture, subordinate and subject in right of payment to the
prior payment in full of all Senior Debt, and this Security is issued subject to the provisions of the Indenture with respect thereto. Each Holder of this Security, by accepting the same, (i) agrees to and shall be bound by such provisions,
(ii) authorizes and directs the Trustee on his or her behalf to take such actions as may be necessary or appropriate to effectuate the subordination so provided and (iii) appoints the Trustee his or her attorney-in-fact for any and all
such purposes. Each Holder hereof, by his or her acceptance hereof, waives all notice of the acceptance of the subordination provisions contained herein and in the Indenture by each holder of Senior Debt, whether now outstanding or hereafter
created, incurred, assumed or guaranteed, and waives reliance by each such holder upon said provisions. 
 6. Remedies.

 Subject to the further provisions of this Security set forth below, if an Event of Default with respect to Securities of this series shall
occur and be continuing, the principal of the Securities of this series shall become automatically due and payable in the manner and with the effect provided in the Indenture. 

Notwithstanding Section 501 of the Indenture, an “Event of Default”, wherever used in the Indenture and herein with respect to
the Securities of this series, shall mean only any one of the events set forth under clauses (5) and (6) of Section 501 of the Indenture. 

Notwithstanding any provision of the Indenture or of the Securities of this series, neither any of the events set forth in Section 501
(other than clauses (5) and (6) of Section 501) nor any other event shall be Events of Default with regard to the Securities of this series. 

  
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 -10- 

 Notwithstanding Section 502 of the Indenture, if an Event of Default with respect to the
Securities of this series at the time Outstanding occurs, the principal amount of all the Securities of this series shall automatically, and without any declaration or other action on the part of the Trustee or any Holder, become immediately due and
payable. Subject to the preceding sentence, the principal amount of the Securities of this series shall not become, pursuant to Section 502 of the Indenture, due and payable prior to the Stated Maturity thereof. 

As provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have the right to institute any
proceeding with respect to the Indenture, or for the appointment of a receiver or trustee, or for any other remedy thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default with respect to
the Securities of this series, the Holders of not less than 25% in principal amount of the Securities of this series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event of Default
as Trustee and offered the Trustee indemnity reasonably satisfactory to it, and the Trustee shall not have received from the Holders of a majority in principal amount of Securities of this series at the time Outstanding a direction inconsistent with
such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the enforcement
of any payment of principal of this Security or any premium or interest on this Security on or after the respective due dates expressed herein. 

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

7. Defeasance. 

The Indenture contains provisions for defeasance at any time of the entire indebtedness of a series of Securities or certain restrictive
covenants and Events of Default with respect to a series of Securities, in each case upon compliance with certain conditions set forth in the Indenture. Neither of such provisions are applicable to this series of Securities. 

8. Modification and Waiver. 

The Indenture permits, with certain exceptions as therein provided, the amendment thereof, and the modification of the rights and obligations
of the Company and the rights of the Holders of the Securities 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 (considered together as one class for this purpose). The Indenture also contains provisions (i) permitting the Holders of a majority in principal amount of the Securities at the time Outstanding of
all series to be affected under the Indenture (considered together as one class for this purpose), on behalf of the Holders of all Securities of such series, to waive compliance by the Company with certain provisions of the Indenture and
(ii) permitting the Holders of a majority in principal amount of the Securities at the 

  
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time Outstanding of any series to be affected under the Indenture (with each such series considered separately for this purpose), on behalf of the Holders of all Securities of such series, to
waive certain past defaults under the Indenture and their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security
issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 

9. Transfer and Exchange. 

As provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Security is registrable in the Security
Register, upon surrender of this Security for registration of transfer at the office or agency of the Company in any place where the principal of and interest on this Security are payable, duly endorsed by, or accompanied by a written instrument of
transfer in form satisfactory to the Company and the Security Registrar duly executed by, the Holder hereof or his or her attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor, of authorized
denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 
 As provided in the
Indenture and subject to certain limitations therein set forth, Securities of this series are exchangeable for a like aggregate principal amount of Securities of this series and of like tenor of a different authorized denomination, as requested by
the Holder surrendering the same. 
 No service charge shall be made for any such registration of transfer or exchange, but the Company may
require payment of a sum sufficient to cover any tax or other governmental charge payable in connection therewith. 
 Prior to due
presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this
Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 
 This Security
is a Global Security and is subject to the provisions of the Indenture relating to Global Securities, including the limitations in Section 305 thereof on transfers and exchanges of Global Securities. 

9. Governing Law. 

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

10. Terms Defined in the Indenture. 

All terms used in this Security which are defined in the Indenture but not otherwise defined herein shall have the meanings assigned to them in
the Indenture. 

  
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 ASSIGNMENT 

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

 
  

 
 PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING
NUMBER OF ASSIGNEE 
  

					
	 		
	 	 		 	

  
  

 
  

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

 
  

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

 
  

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

					
	 Date:
                        
	 		 	  

	  
 Signature Guaranteed

 
      

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

  
 -13-Exhibit 4.1

	

    	
SHARES VIVENTIA   BIO INC. INCORPORATED UNDER THE LAW OF THE PROVINCE OF ONTARIO This is to   Certify that SPECIMEN is the registered holder of Common Shares of VIVENTIA   BIO INC. The class or series of shares represented by this Certificate has   rights, privileges, restrictions or conditions attached thereto and the   Corporation will furnish to the holder, on demand and without charge, a full   copy of the text of, (i) the rights, privileges, restrictions and conditions   attached to the said shares and to each class authorized to be issued and to   each series insofar as the same have been fixed by the directors, and (ii)   the authority of the directors to fix the rights, privileges, restrictions   and conditions of subsequent series, if applicable. LIEN ON SHARES. The corporation   has a lien on the shares represented by this Certificate for any debt of the   shareholder to the corporation. IN WITNESS WHEREOF the Corporation has caused   this certificate to be signed by its duly authorized officers this day of   (year) 
    

 

	

    	
Common Shares   of VIVENTIA BIO INC. ISSUED TO SPECIMEN DATE NOTICE THE SIGNATURE OF THIS   ASSIGNMENT MUST CORRESPOND WITH THE NAME AS WRITTEN UPON THE FACE OF THE   CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE   WHATEVER

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