Document:

Form of Medium-Term Notes, Series P

 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. 95000N2X6 
	
PRINCIPAL AMOUNT: $                   
  

 REGISTERED NO.        

WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES P 

Due Nine Months or More From Date of Issue 

Notes Linked to 3 Month LIBOR due August 30, 2019 

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 August 30, 2019 (the “Stated Maturity Date”) and to pay interest thereon from August 30, 2017 or from the
most recent Interest Payment Date to which interest has been paid or duly provided for quarterly on each February 28, May 30, August 30 and November 30, commencing November 30, 2017, 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 August 30, 2017 and end on and include November 29, 2017. 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 six
Interest Periods (up to and including the Interest Period ending February 27, 2019) will be equal to 1.56% per annum. For all Interest Periods commencing on or after February 28, 2019, 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 Interest Determination Date for such Interest Period plus 0.25%, but in no event will such rate be more
than the Maximum Interest Rate. 
 The “Interest Determination Date” for an Interest Period commencing on
or after February 28, 2019 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 Interest 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 Interest Determination Date that appear on the Designated LIBOR Page as of 11:00 a.m., London time, on that Interest
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 Interest Determination Date to prime banks in the London Interbank market at approximately 11:00 a.m.,
London time, on that Interest 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
Interest 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 Interest 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 Interest Determination Date will remain 3 Month LIBOR for the immediately preceding Interest Period or, if none, the interest rate will be 1.56% per annum. 

The “Maximum Interest Rate” applicable to an Interest Period commencing on or after February 28, 2019 is
2.00% 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 August 30, 2019. 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:	 	 
		 	
		 	Its:	 	

 [SEAL] 
  

					
	Attest:	 	 
		 	
		 	Its:	 	

  

			
	 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 P 

Due Nine Months or More From Date of Issue 

Notes Linked to 3 Month LIBOR due August 30, 2019 

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 P, of the Company, which series is limited to an aggregate principal amount of $25,000,000,000 or the equivalent thereof in one or more foreign or composite currencies.
The Securities of this series will 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. 
 Article Seventeen of the Indenture shall 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. 

Events of Default 

“Event of Default”, whenever used herein with respect to the Securities of this series, means any one of the
following events (whatever the reason for such Event of Default and whether it shall be voluntary or involuntary or be effected by operation of law, pursuant to any judgment, decree or order of any court or any order, rule or regulation of any
administrative or governmental body): 
 (1) default in the payment of any interest upon any Security of
this series when it becomes due and payable, and continuance of such default for a period of 30 days; or 

  
 6 

 (2) default in the payment of the principal of any Security
of this series at its Maturity, and continuance of such default for a period of 30 days; or 
 (3)
default in the performance, or breach, of any covenant or warranty of the Company in the Indenture (other than a covenant or warranty a default in whose performance or whose breach is elsewhere in Section 501 of the Indenture specifically dealt
with or which has expressly been included in the Indenture solely for the benefit of Securities of a series other than the Securities of this series), and continuance of such default or breach for a period of 90 days after there has been given
by registered or certified mail, to the Company by the Trustee, or to the Company and the Trustee by the Holders of at least 25% in principal amount of the Outstanding Securities of this series, a written notice specifying such default or breach and
requiring it to be remedied and stating that such notice is a “Notice of Default” under the Indenture, or 

(4) the failure of the Company, subject to the provisions of Section 1008 of the Indenture, to observe
and perform the covenants contained in Section 1005 of the Indenture; or 
 (5) the entry by a court
having jurisdiction of (A) a decree or order for relief in respect of the Company in an involuntary case or proceeding under any applicable Federal or State bankruptcy, insolvency or similar law or (B) a decree or order adjudging the
Company a bankrupt or insolvent, or approving a petition seeking receivership, insolvency or liquidation of or in respect of the Company under any applicable Federal or State law, or appointing a receiver, liquidator, trustee or similar official of
the Company, or ordering the winding up or liquidation of its affairs, and the continuance of any such decree or order unstayed and in effect for a period of 60 consecutive days; or 

(6) the commencement by the Company of a voluntary case or proceeding under any applicable Federal or State
bankruptcy, insolvency or similar law or of any other case or proceeding to be adjudicated a bankrupt or insolvent, the appointment of a receiver for the Company under any applicable Federal or State bankruptcy, insolvency or similar law following
consent by the Board of Directors of the Company to such appointment, or the entry of a decree or order for relief in respect of the Company in an involuntary case or proceeding under any applicable Federal or State bankruptcy, insolvency,
receivership, liquidation or similar law following the Company’s consent to such decree or order. 
 If an Event of
Default specified in Clause (1), (2), (5) or (6) shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in the manner and with the effect provided in the Indenture. For the
avoidance of doubt, if an Event of Default specified in Clause (3) or (4) shall occur and be continuing, the principal of the Securities of this series may not be declared due and payable. 

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 

  
 7 

 
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 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. 

  
 8 

 This Security may not be transferred except as a whole by the Depositary to
a nominee of the Depositary or by a nominee of the Depositary to the Depositary or another nominee of the Depositary or by the Depositary or any such nominee to a successor of the Depositary or a nominee of such successor. Except as provided above,
owners of beneficial interests in this 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. 

  
 9 

 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)

  
 10 

 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. 

  
 11INDEMNIFICATION
AGREEMENT

 

This
Indemnification Agreement (the “Agreement”) is entered between Chanticleer Holdings, Inc., a Delaware corporation
(the “Company”), and the undersigned, a director, officer, or both, of the Company and/or one or more of its subsidiaries
(“Indemnitee”).

RECITALS

 

	 	A.	The
    Company recognizes the importance, and increasing difficulty, of obtaining adequate liability insurance coverage for its directors,
    officers, employees, agents and fiduciaries.
	 	 	 
	 	B.	The
    Company further recognizes that, at the same time as the availability and coverage of such insurance has become more limited,
    litigation against corporate directors, officers, employees, agents and fiduciaries has continued to increase.
	 	 	 
	 	C.	The
    Company desires to retain and attract the services of highly qualified individuals, such as Indemnitee, to serve the Company
    and, in that connection, also desires to provide contractually for indemnification of, and advancement of expenses to, Indemnitee
    to the full extent authorized by law.

 

For
good and valuable consideration, the parties agree to the terms set forth below.

 

AGREEMENT

 

1.
Indemnification

 

(a)
Scope. The Company agrees to hold harmless and indemnify Indemnitee against any Damages (as defined in Section 1(c)) incurred
by Indemnitee with respect to any Proceeding (as defined in Section 1(d)) to which Indemnitee is or is threatened to be made a
party or in which Indemnitee is otherwise involved (including, but not limited to, as a witness), to the full extent authorized
by law except that Indemnitee shall have no right to indemnification on account of:

 

(i)
acts or omissions of Indemnitee that have been finally adjudged (by a court having proper jurisdiction, and after all rights of
appeal have been exhausted or lapsed, herein “Finally Adjudged”) to be intentional misconduct or a knowing violation
of law;

 

(ii)
conduct of Indemnitee that has been Finally Adjudged to be in violation of the prohibitions against unlawful distributions in
the Statute;

 

(iii)
any transaction with respect to which it has been Finally Adjudged that Indemnitee personally received a benefit in money, property
or services to which Indemnitee was not legally entitled; or

 

(iv)
any suit in which it is Finally Adjudged that Indemnitee is liable for an accounting of profits made from the purchase or sale
by Indemnitee of securities of the Company in violation of the provisions of Section 16(b) of the Securities Exchange Act of 1934
and amendments thereto.

 

(b)
Changes to Indemnification Right. Indemnitee’s right to be indemnified to the full extent authorized by law shall
include the benefits of any change, after the date of this Agreement, in the Statute or other applicable law regarding the right
of a Delaware corporation to indemnify directors or officers, to the extent that it would expand Indemnitee’s rights hereunder.
Any such change that would narrow or interfere with Indemnitee’s rights hereunder shall not apply to, limit, or affect the
interpretation of, this Agreement, unless and then only to the extent that it has been Finally Adjudged that its application hereto
does not constitute an unconstitutional impairment of Indemnitee’s contract rights or otherwise violate applicable law.
In the event the Company grants indemnification rights to any other officer or director that are more favorable to the rights
granted to Indemnitee hereunder, the Indemnitee will automatically, and without any further action, be entitled to substantially
the same benefits set forth in such agreement with such other officer or director.

 

    	1

    	 

    

 

(c)
Indemnified Amounts. If Indemnitee is or is threatened to be made a party to, or is otherwise involved (including, but
not limited to, as a witness) in, any Proceeding, the Company shall hold harmless and indemnify Indemnitee from and against any
and all losses, claims, damages, costs, expenses and liabilities incurred in connection with investigating, defending, being a
witness in, participating in or otherwise being involved in (including on appeal), or preparing to defend, be a witness in, participate
in or otherwise be involved in (including on appeal), such Proceeding, including but not limited to attorney’s fees, judgments,
fines, penalties, ERISA excise taxes, amounts paid in settlement, any federal, state, local or foreign taxes imposed on Indemnitee
as a result of the actual or deemed receipt of any payments pursuant to this Agreement, and other expenses (collectively, “Damages”),
including all interest, assessments or charges paid or payable in connection with or in respect of such Damages.

 

(d)
Definition of Proceeding. For purposes of this Agreement, “Proceeding” shall mean any actual, pending, threatened
or completed action, suit, claim, investigation, hearing or proceeding (whether civil, criminal, administrative or investigative,
and whether formal or informal) in which Indemnitee is, has been, or becomes involved, or regarding which Indemnitee is threatened
to be made a named defendant or respondent, based in whole or in part on or arising out of the fact that Indemnitee is or was
a director, officer, member of a board committee, employee or agent of the Company and/or any of its subsidiaries or that, being
or having been such a director, officer, member of a board committee, employee or agent, Indemnitee is or was serving at the request
of the Company as a director, officer, partner, employee, trustee or agent of another corporation or of a foreign or domestic
corporation, partnership, joint venture, trust, employee benefit plan or other enterprise (each, a “Related Company”),
whether the basis of such action, suit, claim, investigation, hearing or proceeding is alleged action or omission by Indemnitee
in an official capacity as a director, officer, committee member, partner, employee, trustee or agent or in any other capacity
while serving as a director, officer, committee member, partner, employee, trustee or agent. “Proceeding” shall not,
however, include any action, suit, claim, investigation, hearing or proceeding instituted by or at the direction of Indemnitee
unless pursuant to an Enforcement Action (as defined in Section 3(a)) or its institution has been authorized by the Company’s
Board of Directors (the “Board”).

 

(e)
Notifications.

 

(i)
Promptly after receipt by Indemnitee of notice of the commencement (including a threatened assertion or commencement) of any Proceeding,
Indemnitee will, if it is reasonably foreseeable that a claim in respect thereof will be made against the Company under this Agreement,
notify the Chair of the Board’s Audit Committee of the commencement thereof (the “Indemnification Notice”).
A failure to notify the Company in accordance with this subsection (e)(i) will not, however, relieve the Company from any liability
to Indemnitee under this Agreement unless (and then only to the extent that) such failure is Finally Adjudged to have materially
prejudiced the Company’s ability to defend the Proceeding.

 

    	2

    	 

    

 

 

(ii)
At the same time, or from time to time thereafter, Indemnitee may further notify the Chair of the Board’s Audit Committee,
by delivery of a supplemental Indemnification Notice (or by checking the second box and providing the corresponding information
on the initial Indemnification Notice), of any Proceeding for which indemnification is being sought under this Agreement.

 

(f)
Determination of Entitlement.

 

(i)
To the extent Indemnitee has been wholly successful, on the merits or otherwise, in the defense of any Proceeding, the Company
shall indemnify Indemnitee against all expenses incurred by Indemnitee in connection with the Proceeding, within ten (10) days
after receipt of an Indemnification Notice delivered pursuant to subsection (e)(ii).

 

(ii)
In the event that subsection (f)(i) above is inapplicable, or does not apply to the entire Proceeding, the Company shall indemnify
Indemnitee within thirty (30) days after receipt of an Indemnification Notice delivered pursuant to subsection (e)(ii) unless
during such thirty (30) day period the Audit Committee of the Board delivers to Indemnitee a written notice contesting Indemnitee’s
indemnification claim (the “Contest Notice”), which Contest Notice shall state with particularity the reasons for
the decision to challenge Indemnitee’s indemnification claim and the evidence the Company would present in any forum in
which Indemnitee might seek review of such decision. The Company’s failure to deliver a Contest Notice within thirty (30)
days after the Company’s receipt of an Indemnification Notice pursuant to subsection (e)(ii) shall obligate the Company
unconditionally to indemnify Indemnitee to the extent requested in the Indemnification Notice.

 

(iii)
At any time following receipt of a Contest Notice, Indemnitee shall be entitled to select a forum for the review of, and in which
the Company will defend, the Contest Notice and the Company’s decision to challenge Indemnitee’s indemnification claim.
Such selection shall be made from among the following alternatives, by delivering a written notice to the Chair of the Board’s
Audit Committee indicating Indemnitee’s selection of forum:

 

(a)
A quorum of the Board consisting of directors who are not parties to the Proceeding for which indemnification is being sought;

 

(b)
Special Legal Counsel (as defined in subsection (f)(vii) below); or

 

(c)
A panel of three independent arbitrators, one of whom is selected by the Company, another of whom is selected by Indemnitee and
the last of whom is selected by the first two arbitrators so selected,

 

provided,
that nothing in this Section 1(f) shall prevent Indemnitee at any time from bringing suit against the Company to recover the amount
of the indemnification claim (whether or not Indemnitee has otherwise exhausted its contractual remedies hereunder). In addition,
any determination by a forum selected by Indemnitee that Indemnitee is not entitled to indemnification, or any failure to make
the payments requested in the Indemnification Notice, shall be subject to judicial review by any court of competent jurisdiction,
as described in Section 3.

 

(iv)
In any forum in which the Company defends its Contest Notice and its decision to challenge Indemnitee’s indemnification
claim under this Section 1(f), the presumptions, burdens and standard of review set forth in Section 3(c) shall apply and are
incorporated into this Section 1(f) by reference, except as otherwise expressly provided in Section 3(c).

 

    	3

    	 

    

 

(v)
As soon as practicable, and in no event later than fifteen (15) days after the forum has been selected pursuant to subsection
(f)(iii) above, the Company shall, at its own expense, submit the defense of its Contest Notice and the question of Indemnitee’s
right to indemnification to the selected forum.

 

(vi)
The forum selected shall render its decision concerning the validity of the Contest Notice and the Company’s decision to
deny Indemnitee’s indemnification claim within thirty (30) days after the forum has been selected in accordance with subsection
(f)(iii).

 

(vii)
For the purposes of this Agreement, “Special Legal Counsel” shall mean an attorney or firm of attorneys, selected
by Indemnitee and approved by the Company (which approval shall not be unreasonably withheld), who must not have performed other
services for the Company or Indemnitee within the last three years.

 

2.
Expense Advances.

 

(a)
Generally. The right to indemnification conferred by Section 1 shall include the right to have the Company pay Indemnitee’s
attorney’s fees and other expenses, including but not limited to out of pocket costs and disbursements, incurred in connection
with any Proceeding, or in connection with bringing, defending and/or pursuing an Enforcement Action (as defined in Section 3(a)),
as such expenses are incurred and in advance of the final disposition of such Proceeding or Enforcement Action (such entitlement
is referred to hereinafter as an “Expense Advance”).

 

(b)
Undertaking. The Company’s obligation to provide an Expense Advance is subject only to the following condition: if
the Proceeding arose in connection with Indemnitee’s service as a director and/or officer of the Company or member of a
committee of the Board (and not in any other capacity in which Indemnitee rendered service, including but not limited to service
to any Related Company), then Indemnitee or his or her representative must have executed and delivered to the Chair of the Board’s
Audit Committee an undertaking (the “Statement of Undertaking”) to repay all Expense Advances if and to the extent
that it may be Finally Adjudged that Indemnitee is not entitled to be indemnified for such Expense Advance under one or more of
clauses (i) through (iv) of the first sentence of Section 1(a). The Statement of Undertaking need not be secured and shall be
accepted by the Company without reference to Indemnitee’s financial ability to make repayment. No interest shall be charged
on any obligation to reimburse the Company for any Expense Advance.

 

(c)
Service as Witness. Notwithstanding any other provision of this Agreement, the Company’s obligation to indemnify,
or provide Expense Advances under Section 2, to Indemnitee in connection with Indemnitee’s appearance as a witness in a
Proceeding at a time when Indemnitee has not been made a named defendant or respondent to the Proceeding shall be absolute and
unconditional, and not subject to any of the limitations on, or conditions to, Indemnitee’s right to indemnification or
to receive an Expense Advance otherwise contained in this Agreement.

 

3.
Procedures for Enforcement.

 

(a)
Enforcement. If a claim for indemnification made by Indemnitee hereunder is not paid in full (whether or not the provisions
of Section 1(f) have been complied with, or completed), or a claim for an Expense Advance made by Indemnitee hereunder is not
paid in full within twenty (20) days from delivery of a Statement of Undertaking to the Chair of the Board’s Audit Committee,
Indemnitee may, but need not, at any time thereafter bring suit against the Company to recover the unpaid amount of the claim
(an “Enforcement Action”).

 

    	4

    	 

    

 

(b)
Required Indemnification. The court hearing the Enforcement Action shall order the Company to provide indemnification or
to advance expenses to Indemnitee to the full extent sought in the Enforcement Action if it determines that (i) the Enforcement
Action is brought by Indemnitee to enforce the Company’s obligation under Section 1(f)(ii) unconditionally to indemnify
Indemnitee to the extent requested in the Indemnification Notice where the Company has failed timely to deliver a Contest Notice,
(ii) the Company failed to prove by clear and convincing evidence that Indemnitee is not entitled to indemnification based on
one or more of clauses (i) through (iv) of the first sentence of Section 1(a), or (iii) Section 2(c) applies.

 

(c)
Presumptions, Burdens and Standard of Review in Enforcement Action or Company Determination. In any Enforcement Action
(and, except as otherwise expressly provided in this Section 3(c), in any review of a Contest Notice by a forum described in Section
1(f)) the following presumptions (and limitations on presumptions), burdens and standard of review shall apply:

 

	 	(i)	The
    Company shall conclusively be presumed to have entered into this Agreement and assumed the obligations imposed hereunder in
    order to induce Indemnitee to serve or to continue to serve as an director and/or officer of the Company and/or one or more
    of its subsidiaries;
	 	 	 
	 	(ii)	This
    Agreement shall conclusively be presumed to be valid and Article 5 of the Certificate shall conclusively be presumed to be
    effective to waive all of the applicable limitations in the Statute regarding indemnification;
	 	 	 
	 	(iii)	Submission
    of an Indemnification Notice in accordance with Section 1(e)(ii) or a Statement of Undertaking to the Company shall create
    a presumption that Indemnitee is entitled to indemnification or an Expense Advance hereunder, and thereafter the Company shall
    have the burden of proving by clear and convincing evidence (sufficient to rebut the foregoing presumption) that Indemnitee
    is not entitled to indemnification based on one or more of clauses (i) through (iv) of the first sentence of Section 1(a);
	 	 	 
	 	(iv)	Indemnitee
    may establish a conclusive presumption of any objective fact related to an event or occurrence by delivering to the Company
    a declaration made under penalty of perjury that such fact is true, provided, that no such presumption may be established
    with respect to the ultimate conclusions set forth in any of clauses (i) through (iv) of the first sentence of Section 1(a);
	 	 	 
	 	(v)	If
    Indemnitee is or was serving as a director, officer, employee, trustee or agent of a corporation of which a majority of the
    shares entitled to vote in the election of its directors is held by the Company or in an executive or management capacity
    in a partnership, joint venture, trust or other enterprise of which the Company or a wholly-owned subsidiary of the Company
    is a general partner or has a majority ownership, then such corporation, partnership, joint venture, trust or enterprise shall
    conclusively be deemed a Related Company and Indemnitee shall conclusively be deemed to be serving such Related Company at
    the request of the Company;

 

    	5 

    	 

    

 

	 	(vi)	Neither
    (a) the failure of the Company (including but not limited to the Board, the Company’s officers, independent counsel,
    Special Legal Counsel, any arbitrator or the Company’s shareholders) to make a determination prior to the commencement
    of the Enforcement Action whether indemnification, or payment of an Expense Advance, of Indemnitee is proper in the circumstances,
    nor (b) an actual determination by the Company, the Board, the Company’s officers, independent counsel, Special Legal
    Counsel, any arbitrator or the Company’s shareholders that Indemnitee is not entitled to indemnification or payment
    of an Expense Advance shall be a defense to the Enforcement Action, create a presumption that Indemnitee is not entitled to
    indemnification hereunder or be considered by a court in an Enforcement Action, which shall conduct a de novo review of the
    relevant issues; and
	 	 	 
	 	(vii)	If
    the court hearing the Enforcement Action is unable to make either of the determinations specified in Sections 3(b)(i) or 3(b)(ii),
    the court hearing the Enforcement Action shall nonetheless order the Company to provide indemnification or to advance expenses
    to Indemnitee to the full extent sought in the Enforcement Action if it determines that Indemnitee is fairly and reasonably
    entitled to such indemnification or Expense Advance in view of all of the relevant circumstances, and without regard to the
    limitations set forth in clauses (i) through (iii) of the first sentence of Section 1(a). In determining whether Indemnitee
    is fairly and reasonably entitled to such indemnification or expense advance, the court shall weigh (a) the relative benefits
    received by the Company and/or any of its subsidiaries or any Related Company, or any of their affiliates other than Indemnitee,
    on the one hand, and Indemnitee on the other from the transaction from which such Proceeding arose or to which such Proceeding
    relates, and (b) the relative fault of the Company and/or any of its subsidiaries or any Related Company, or any of their
    affiliates other than Indemnitee, on the one hand, and of Indemnitee on the other in connection with the transaction that
    resulted in such Damages, as well as any other relevant equitable considerations. The relative fault of the Company and/or
    any of its subsidiaries or any Related Company, or any of their affiliates other than Indemnitee, on the one hand, and of
    Indemnitee on the other shall be determined by reference to, among other things, the parties’ relative intent, knowledge,
    access to information and opportunity to correct or prevent the circumstances resulting in such Damages. If either (Y) the
    relative benefits received by the Company and/or any of its subsidiaries or any Related Company, or any of their affiliates
    other than Indemnitee, exceed the relative benefits received by Indemnitee, or (Z) the relative fault of the Company and/or
    any of its subsidiaries or any Related Company, or any of their affiliates other than Indemnitee, exceeds the relative fault
    of Indemnitee, then Indemnitee shall be entitled to the full amount of indemnification and/or Expense Advance sought in the
    Enforcement Proceeding.

 

(d)
Attorneys’ Fees and Expenses for Enforcement Action. In any Enforcement Action, the Company shall hold harmless and
indemnify Indemnitee against all of Indemnitee’s attorney’s fees and expenses in bringing, defending and/or pursuing
the Enforcement Action (including but not limited to attorney’s fees at any stage, and on appeal); provided, however, that
the Company shall not be required to provide such indemnification for such fees and expenses if it is Finally Adjudged that Indemnitee
knew prior to commencement of the Enforcement Action that Indemnitee was not entitled to indemnification based on any of clauses
(i) through (iv) of the first sentence of Section 1(a).

 

    	6 

    	 

    

 

4.
Defense of Claim. With respect to any Proceeding as to which Indemnitee has provided notice
to the Company pursuant to Section 1(e)(i):

 

(a)
The Company may participate therein at its own expense.

 

(b)
The Company (jointly with any other indemnifying party similarly notified, if any) may assume the defense thereof, with counsel
reasonably satisfactory to Indemnitee. After notice from the Company to Indemnitee of its election to so assume the defense thereof,
the Company shall not be liable to Indemnitee under this Agreement for any legal fees or other expenses (other than reasonable
costs of investigation) subsequently incurred by Indemnitee in connection with the defense thereof unless (i) the employment of
counsel by Indemnitee or the incurring of such expenses has been authorized by the Company, (ii) Indemnitee shall have concluded
that there is a reasonable possibility that a conflict of interest could arise between the Company and Indemnitee in the conduct
of the defense of such Proceeding, which conflict of interest shall be conclusively presumed to exist upon Indemnitee’s
delivery to the Company of a written certification of such conclusion, or (iii) the Company shall not in fact have employed counsel
to assume the defense of such Proceeding, in each of which cases the legal fees and other expenses of Indemnitee shall be at the
expense of the Company. The Company shall not be entitled to assume the defense of a Proceeding brought by or on behalf of the
Company or as to which Indemnitee shall have reached the conclusion described in clause (ii) above.

 

(c)
The Company shall not be liable for any amounts paid in settlement of any Proceeding effected without its written consent.

 

(d)
The Company shall not settle any Proceeding in any manner that would impose any penalty or limitation on Indemnitee without Indemnitee’s
written consent.

 

(e)
Neither the Company nor Indemnitee will unreasonably withhold its or his or her consent to any proposed settlement of any Proceeding.

 

(f)
In addition to all the requirements above, if Company has directors and officers liability insurance, or other insurance, with
a panel counsel requirement that may be triggered then or at some future point by the matter for which indemnity is owed to Indemnitee,
then Indemnitee shall use such panel counsel, unless there is an actual conflict of interest with representation by all such panel
counsel, or unless and to the extent Company waives such requirement in writing.

 

5.
Maintenance of D&O Insurance.

 

(a)
Subject to Section 5(c) below, during the period (the “Coverage Period”) beginning on the date of this Agreement and
ending at the later of six (6) years following the time Indemnitee is no longer serving as either a director or officer of the
Company and/or one or more subsidiaries or any Related Company, or at the end of such longer period during which Indemnitee believes
that a reasonable possibility of exposure to a Proceeding or Damages persists (which extended period must be consented to by the
Company, such consent not to be unreasonably withheld), the Company shall maintain a directors’ and officers’ liability
insurance policy in full force and effect or shall have purchased or otherwise provided for a run-off or tail policy or endorsement
to such existing policy (“D&O Insurance”), providing in all respects coverage at least comparable to and in similar
amounts, and with similar exclusions, as that obtained by other similarly situated companies as determined in good faith by any
of the parties referenced in Section 1(f)(iii)(a) through (c).

 

    	7

    	 

    

 

(b)
Under all policies of D&O Insurance, Indemnitee shall during the Coverage Period be named as an insured in such a manner as
to provide Indemnitee the same rights and benefits, subject to the same limitations, as are accorded to the Company’s directors
or officers most favorably insured by such policy, and each insurer under a policy of D&O Insurance shall be required to provide
Indemnitee written notice at least thirty (30) days prior to the effective date of termination of the policy.

 

(c)
The Company shall have no obligation to obtain or maintain D&O Insurance to the extent that such insurance is not reasonably
available, the premium costs for such insurance are disproportionate to the amount of coverage provided, or the coverage provided
by such insurance is so limited by exclusions as to provide an insufficient benefit, such determination to be made by any of the
parties referenced in Section 1(f)(iii)(a) through (c).

 

(d)
It is the intention of the parties in entering into this Agreement that the insurers under the D&O Insurance, if any, shall
be obligated ultimately to pay any claims by Indemnitee which are covered by D&O Insurance, and nothing herein shall be deemed
to diminish or otherwise restrict the Company’s or Indemnitee’s right to proceed or collect against any insurers under
D&O Insurance or to give such insurers any rights against the Company or Indemnitee under or with respect to this Agreement,
including but not limited to any right to be subrogated to the Company’s or Indemnitee’s rights hereunder, unless
otherwise expressly agreed to by the Company and Indemnitee in writing. The obligation of such insurers to the Company and Indemnitee
shall not be deemed reduced or impaired in any respect by virtue of the provisions of this Agreement.

 

(e)
No indemnification pursuant to this Agreement shall be provided by the Company for Damages or Expense Advances that have been
paid directly to Indemnitee by an insurance carrier under a policy of D&O Insurance or other insurance maintained by the Company.

 

(f)
In the event of payment under this Agreement, the Company shall be subrogated to the extent of such payment to all of the rights
of Indemnitee to recover the same amounts from any insurer or other third person (other than another person with indemnification
rights against the Company substantially similar those of Indemnitee under this Agreement). Indemnitee shall execute all documents
required and take all acts necessary to secure such rights and enable the Company effectively to bring suit to enforce such rights.

 

6.
Partial Indemnification; Mutual Acknowledgment; Contribution.

 

(a)
Partial Indemnification. If Indemnitee is entitled under any provision of this Agreement to indemnification by the Company
for some or a portion of any Damages in connection with a Proceeding, but not for the total amount thereof, the Company shall
nevertheless indemnify Indemnitee for the portion of such Damages to which Indemnitee is entitled.

 

(b)
Mutual Acknowledgment. The Company and Indemnitee acknowledge that, in certain instances, federal law or public policy
may override applicable state law and prohibit the Company from indemnifying Indemnitee under this Agreement or otherwise. For
example, the Company and Indemnitee acknowledge that the Securities and Exchange Commission (the “SEC”) has taken
the position that indemnification is not permissible for liabilities arising under certain federal securities laws, and federal
legislation prohibits indemnification for certain ERISA violations. Furthermore, Indemnitee understands that the Company has undertaken
or may be required in the future to undertake with the SEC to submit for judicial determination the issue of the Company’s
power to indemnify Indemnitee in certain circumstances; all of the Company’s obligations under this Agreement will be subject
to the requirements of any such undertaking required by the SEC to be made by the Company.

 

    	8

    	 

    

 

(c)
Contribution. If the indemnification provided under Sections 1, 2 and 6 is unavailable by reason of any of the circumstances
specified in one or more of clauses (i) through (iii) of the first sentence of Section 1(a) then, in respect of any Proceeding
in which the Company is jointly liable with Indemnitee (or would be if joined in such Proceeding), the Company shall contribute
to the amount of Damages (including attorney’s fees) actually and reasonably incurred and paid or payable by Indemnitee
in such proportion as is appropriate to reflect (i) the relative benefits received by the Company and/or any of its subsidiaries
or any Related Company, or any of their affiliates other than Indemnitee, on the one hand, and Indemnitee on the other from the
transaction or events from which such Proceeding arose or to which such Proceeding relates, and (ii) the relative fault of the
Company and/or any of its subsidiaries or any Related Company, or any of their affiliates other than Indemnitee, on the one hand,
and of Indemnitee on the other in connection with the transaction or events that resulted in such Damages, as well as any other
relevant equitable considerations. The relative fault of the Company and/or any of its subsidiaries or any Related Company, or
any of their affiliates other than Indemnitee, on the one hand, and of Indemnitee on the other shall be determined by reference
to, among other things, the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent
the circumstances resulting in such Damages. The Company agrees that it would not be just and equitable if contribution pursuant
to this Section 6(c) were determined by pro rata allocation or any other method of allocation that does not take account of the
foregoing equitable considerations.

 

7.
Release of Claims Relating to Officer’s
Failure to Discharge Duties. If Indemnitee is an officer of the Company and/or one or more of
its subsidiaries, the indemnification and other rights and benefits provided to Indemnitee by this Agreement shall apply fully
with respect to any Proceeding in which it is claimed or adjudicated that Indemnitee is liable to the Company and/or one or more
of its subsidiaries by reason of having failed to discharge the duties of Indemnitee’s office, and the Company hereby irrevocably
releases all such claims and liabilities, agrees to cause its subsidiaries to release all such claims, and agrees to hold Indemnitee
harmless with respect to any such claims; provided, however, that the foregoing indemnification, release and hold harmless obligations
of the Company shall have no application with respect to claims by and liabilities to the Company based upon actions or omissions
described in one or more of clauses (i) through (iv) of the first sentence of Section 1(a).

 

8.
Miscellaneous.

 

(a)
This Agreement shall be interpreted and enforced in accordance with the laws of the State of Delaware.

 

(b)
This Agreement shall be binding upon Indemnitee and upon the Company, its successors and assigns, and shall inure to the benefit
of Indemnitee, Indemnitee’s heirs, personal representatives and assigns and to the benefit of the Company, its successors
and assigns. The Company shall require any successor to the Company (whether direct or indirect, by purchase, merger, consolidation
or otherwise) to all or substantially all of the business or assets of the Company, expressly to assume and agree to perform this
Agreement in the same manner and to the same extent that the Company would be required to perform if no such succession had taken
place.

 

(c)
Indemnitee’s rights to indemnification and advancement of expenses under this Agreement shall not be deemed exclusive of
any other or additional rights to which Indemnitee may be entitled under the Certificate or the Bylaws of the Company, any vote
of shareholders or disinterested directors, the Statute or otherwise, whether as to actions or omissions in Indemnitee’s
official capacity or otherwise. The Company hereby acknowledges that Indemnitee has or may have certain rights to indemnification,
advancement of expenses and/or insurance provided by third party indemnitors, such as an employer. The Company hereby agrees (i)
that the Company is the indemnitor of first resort (i.e., the Company’s obligations to Indemnitee are primary and any obligation
of the third party indemnitors to advance expenses or to provide indemnification for the same expenses or liabilities incurred
by Indemnitee are secondary) and (ii) that the Company shall be required to advance the full amount of expenses incurred by Indemnitee
and shall be liable for the full amount of all Damages and Expense Advances required by the terms of this Agreement, the Certificate
and the Bylaws, without regard to any rights Indemnitee may have against third party indemnitors. The Company further agrees that
no advancement or payment by the third party indemnitors on behalf of Indemnitee with respect to any claim for which Indemnitee
has sought indemnification or advancement from the Company shall affect the foregoing and the third party indemnitors shall have
a right of contribution and/or be subrogated to the extent of such advancement or payment to all of the rights of recovery of
Indemnitee against the Company.

 

    	9

    	 

    

 

(d)
Nothing in this Agreement shall confer upon Indemnitee the right to continue to serve as a director and/or officer of the Company
or any of its subsidiaries or any Related Company. If Indemnitee is an officer of the Company, then, unless otherwise expressly
provided in a written employment agreement between the Company and Indemnitee, the employment of Indemnitee with the Company shall
be terminable at will by either party. The indemnification and release provided under this Agreement shall apply to any and all
Proceedings, notwithstanding that Indemnitee has ceased to be a director, officer, partner, employee, trustee or agent of the
Company, any of its subsidiaries or a Related Company, and shall inure to the benefit of the heirs, executors and administrators
of Indemnitee.

 

(e)
If any provision or provisions of this Agreement shall be held to be invalid, illegal or unenforceable for any reason whatsoever,
then: (i) the validity, legality and enforceability of the remaining provisions of this Agreement (including, without limitation,
all portions of any paragraphs of this Agreement containing any such invalid, illegal or unenforceable provision that are not
themselves invalid, illegal or unenforceable) shall not in any way be affected or impaired thereby; and (ii) to the fullest extent
possible, the provisions of this Agreement (including, without limitation, all portions of any paragraphs of this Agreement containing
any such invalid, illegal or unenforceable provision, that are not themselves invalid, illegal or unenforceable) shall be construed
so as to give effect to the intent manifested by the provision held invalid, illegal or unenforceable.

 

(f)
Any notices or communications to be given or required to be given under this Agreement shall be given by personal delivery or
registered airmail, overnight courier, telex, facsimile or electronic mail at the address set forth on the signature page hereto
(or such other address as the relevant party provides the other party in writing. Notices and communications shall be deemed received
by the addressee on the date of delivery if delivered in person, on the third (3rd) day after mailing if delivered
by registered airmail, on the next business day after mailing if sent by overnight courier, on the next business day if sent by
telex or facsimile, or upon confirmation of delivery when directed to the electronic mail address described above if sent by electronic
mail.

 

(g)
No amendment, modification, termination or cancellation of this Agreement shall be effective unless in writing signed by both
parties hereto.

 

(h)
If Indemnitee has previously executed an indemnification agreement with the Company, this Agreement supersedes such prior indemnification
agreement in its entirety.

 

(i)
This Agreement may be executed in two counterparts, each of which shall be deemed an original, but both of which together shall
constitute one and the same instrument.

 

[signature
page follows]

 

    	10

    	 

    

 

IN
WITNESS WHEREOF, the parties have executed and delivered this Agreement effective as of the last date indicated below.

 

	“COMPANY”	 	“INDEMNITEE”
	CHANTICLEER HOLDINGS, INC.,	 	an individual
	a Delaware corporation	 	 

 

	By:	 	 	By:	 
	Name:	Michael D. Pruitt	 	Print Name:
	Title:	Chief Executive Officer	 	 	 
	Date:	 	 	Date:	 
	Address	 	Address

 

 

 

    	SIGNATURE
                                         PAGE TO CHANTICLEER HOLDINGS, INC. INDEMNIFICATION AGREEMENT

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00274-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00274-of-00352.parquet"}]]