Document:

Form of Global Security relating thereto

 Exhibit 4.2 
 (Face of Security) 
 THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND
IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY 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 BARCLAYS BANK PLC, 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. 
 BY PURCHASING THIS SECURITY, THE HOLDER AGREES TO CHARACTERIZE THIS SECURITY FOR ALL U.S. FEDERAL INCOME TAX PURPOSES AS PROVIDED IN SECTION 7 ON THE FACE OF THIS SECURITY. 

			
	CUSIP No.	  	ISIN:
		  	Common Code:

 BARCLAYS BANK PLC 
 MEDIUM-TERM NOTES, SERIES A 
  

 iPathSM MSCI India
IndexSM ETN 
 due December 18, 2036 
 The following terms apply to this Security. Capitalized terms that are
not defined the first time they are used in this Security shall have the meanings indicated elsewhere in this Security. 
  

			
	 Face Amount:
  
 Index: MSCI India Total Return IndexSM.
  
 Inception Date: December 19, 2006.
  
 Interest Rate: The principal of this Security shall not bear interest.
  
 Denomination: $50.
  
 Payment at Maturity: On the Maturity Date, the Company shall redeem this Security by paying
to the Holder a cash payment equal to the principal amount of the Holder’s Securities times the Index Factor on the Final Valuation Date minus the Investor Fee on the Final Valuation Date unless such Securities were previously
redeemed on a Redemption Date as provided under “Early Redemption”.
	  	 Early Redemption: The Holder may, subject to the notification requirements provided under Section 5 hereof, require the Company to
redeem the Holder’s Securities in whole or in part on any Redemption Date during the term of the Securities. If the Holder requires the Company to redeem the Holder’s Securities on any Redemption Date, the Holder will receive a cash
payment equal to the principal amount of the Holder’s Securities times the Index Factor on the applicable Valuation Date minus the Investor Fee on the applicable Valuation Date, less the Redemption Charge. The Company shall not be
required to redeem fewer than 50,000 Securities at one time, provided that the Company may from time to time in its sole discretion reduce, in part or in whole, this minimum redemption amount on a consistent basis for all Holders who hold
Securities at the time the reduction becomes effective.
  
 Calculation Agent:
Barclays Bank PLC.
  
 Defeasance: Neither full defeasance nor covenant defeasance
applies to this Security.
  
 Listing: New York Stock
Exchange.

	  
	  
	  
	  
	  
	  

  

 (Face of Security continued on next page) 
 –2– 

 MSCI has entered into a license agreement granting to Barclays Bank PLC a non-transferable, non-exclusive license to use
the Index in connection with the Securities. 
 THE SECURITIES ARE NOT SPONSORED OR ENDORSED BY MSCI, ANY AFFILIATE OF MSCI OR ANY OTHER PARTY INVOLVED IN,
OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX. THE SECURITIES ARE NOT SOLD OR PROMOTED BY MSCI, ANY AFFILIATE OF MSCI OR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX. THE MSCI INDEXES ARE THE EXCLUSIVE
PROPERTY OF MSCI. MSCI AND THE MSCI INDEX NAMES ARE SERVICE MARK(S) OF MSCI OR ITS AFFILIATES AND HAVE BEEN LICENSED FOR USE FOR CERTAIN PURPOSES BY BARCLAYS BANK PLC. NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR
RELATED TO, MAKING OR COMPILING ANY MSCI INDEX MAKES ANY REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, TO THE OWNERS OF THE SECURITIES OR ANY MEMBER OF THE PUBLIC REGARDING THE ADVISABILITY OF INVESTING IN FINANCIAL SECURITIES GENERALLY OR IN THE
SECURITIES PARTICULARLY OR THE ABILITY OF ANY MSCI INDEX TO TRACK CORRESPONDING STOCK MARKET PERFORMANCE. MSCI OR ITS AFFILIATES ARE THE LICENSORS OF CERTAIN TRADEMARKS, SERVICE MARKS AND TRADE NAMES AND OF THE MSCI INDEXES WHICH ARE
DETERMINED, COMPOSED AND CALCULATED BY MSCI WITHOUT REGARD TO THE SECURITIES OR TO BARCLAYS BANK PLC OR ANY OWNER OF THE SECURITIES. NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY
MSCI INDEX HAS ANY OBLIGATION TO TAKE THE NEEDS OF BARCLAYS BANK PLC OR OWNERS OF THE SECURITIES INTO CONSIDERATION IN DETERMINING, COMPOSING OR CALCULATING THE MSCI INDEXES. NEITHER MSCI, ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR
RELATED TO, MAKING OR COMPILING ANY MSCI INDEX IS RESPONSIBLE FOR OR HAS PARTICIPATED IN THE DETERMINATION OF THE TIMING OF, PRICES AT, OR QUANTITIES OF THE SECURITIES TO BE ISSUED OR IN THE DETERMINATION OR CALCULATION OF THE EQUATION BY WHICH THE
SECURITIES ARE REDEEMABLE FOR CASH. NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, THE MAKING OR COMPILING ANY MSCI INDEX HAS ANY OBLIGATION OR LIABILITY TO THE OWNERS OF THE SECURITIES IN CONNECTION WITH
THE ADMINISTRATION, MARKETING OR OFFERING OF THE SECURITIES. NOTWITHSTANDING THE FOREGOING, CERTAIN AFFILIATES OF MSCI MAY ACT AS DEALERS IN CONNECTION WITH THE SALE OF THE SECURITIES AND, AS SUCH, MAY SELL OR PROMOTE THE SECURITIES OR MAY BE
INVOLVED IN THE ADMINISTRATION, MARKETING OR OFFERING OF THE SECURITIES. 
 ALTHOUGH MSCI SHALL OBTAIN INFORMATION FOR INCLUSION IN OR FOR USE IN THE
CALCULATION OF THE MSCI INDEXES FROM SOURCES WHICH MSCI CONSIDERS RELIABLE, NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX WARRANTS OR GUARANTEES THE ORIGINALITY, ACCURACY
AND/OR THE COMPLETENESS OF ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN. NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX MAKES ANY WARRANTY, EXPRESS OR IMPLIED, AS TO RESULTS
TO BE OBTAINED BY BARCLAYS BANK PLC, BARCLAYS BANK PLC’S CUSTOMERS OR 

  

 (Face of Security continued on next page) 
 –3– 

 
COUNTERPARTIES, OWNERS OF THE SECURITIES, OR ANY OTHER PERSON OR ENTITY, FROM THE USE OF ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN IN CONNECTION WITH THE
RIGHTS LICENSED THEREUNDER OR FOR ANY OTHER USE. NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX SHALL HAVE ANY LIABILITY FOR ANY ERRORS, OMISSIONS OR INTERRUPTIONS OF OR IN
CONNECTION WITH ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN. FURTHER, NEITHER MSCI, ANY OF ITS AFFILIATES NOR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX MAKES ANY EXPRESS OR IMPLIED WARRANTIES OF ANY KIND, AND
MSCI, ANY OF ITS AFFILIATES AND ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX HEREBY EXPRESSLY DISCLAIM ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, WITH RESPECT TO ANY MSCI INDEX AND ANY
DATA INCLUDED THEREIN. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT SHALL MSCI, ANY OF ITS AFFILIATES OR ANY OTHER PARTY INVOLVED IN, OR RELATED TO, MAKING OR COMPILING ANY MSCI INDEX HAVE ANY LIABILITY FOR ANY DIRECT, INDIRECT, SPECIAL,
PUNITIVE, CONSEQUENTIAL OR ANY OTHER DAMAGES (INCLUDING LOST PROFITS) EVEN IF NOTIFIED OF THE POSSIBILITY OF SUCH DAMAGES. 
 No purchaser, seller or holder
of the Securities, nor any other person or entity, should use or refer to any MSCI trade name, trademark or service mark to sponsor, endorse, market or promote the Securities without first contacting MSCI to determine whether MSCI’s permission
is required. Under no circumstances may any person or entity claim any affiliation with MSCI without the prior written permission of MSCI. 
 OTHER TERMS:

 All terms used in this Security that are not defined in this Security but are defined in the Indenture referred to on the reverse of
this Security shall have the meanings assigned to them in the Indenture. Section headings on the face of this Security are for convenience only and shall not affect the construction of this Security. 
 “Business Day” means any day that is not a Saturday, a Sunday or a day on which banking institutions in London or New York City
generally are authorized or obligated by law, regulation or executive order to close. 
 “Default Amount” means, on any day,
an amount in U.S. dollars, as determined by the Calculation Agent in its sole discretion, equal to the cost of having a Qualified Financial Institution (selected as provided below) expressly assume the due and punctual payment of the principal of
this Security, and the performance or observance of every covenant hereof and of the Indenture on the part of the Company to be performed or observed with respect to this Security (or to undertake other obligations providing substantially equivalent
economic value to the Holder of this Security as the Company’s obligations hereunder). Such cost will equal (i) the lowest amount that a Qualified Financial Institution would charge to effect such assumption (or undertaking) plus
(ii) the reasonable expenses (including reasonable attorneys’ fees) incurred by the Holder of this Security in preparing any documentation necessary for such assumption (or undertaking). During the Default Quotation Period, each Holder of
this Security and the Company may request a 

  

 (Face of Security continued on next page) 
 –4– 

 
Qualified Financial Institution to provide a quotation of the amount it would charge to effect such assumption (or undertaking). If either party obtains a
quotation, it must notify the other party in writing of the quotation. The amount referred to in clause (i) of this paragraph will equal the lowest (or, if there is only one, the only) quotation so obtained, and as to which notice is so given,
during the Default Quotation Period; provided that, with respect to any quotation, the party not obtaining the quotation may object, on reasonable and significant grounds, to the effectuation of such assumption (or undertaking) by the
Qualified Financial Institution providing such quotation and notify the other party in writing of such grounds within two Business Days after the last day of the Default Quotation Period, in which case that quotation will be disregarded in
determining the Default Amount. The “Default Quotation Period” shall be the period beginning on the day the Default Amount first becomes due and ending on the third Business Day after such due date, unless no such quotation is
obtained, or unless every such quotation so obtained is objected to within five Business Days after such due date as provided above, in which case the Default Quotation Period will continue until the third Business Day after the first Business Day
on which prompt notice of a quotation is given as provided above, unless such quotation is objected to as provided above within five Business Days after such first Business Day, in which case, the Default Quotation Period will continue as provided
in this sentence. Notwithstanding the foregoing, if the Default Quotation Period (and the subsequent two Business Day objection period) has not ended prior to the Final Valuation Date, then the Default Amount will equal the Face Amount. 

“Final Valuation Date” means December 11, 2036, or if such date is not a Trading Day, the next succeeding Trading Day;
provided, however, that if the Calculation Agent determines that a Market Disruption Event occurs or is continuing on such date, the Final Valuation Date will be the first following Trading Day on which the Calculation Agent determines
that a Market Disruption Event does not occur and is not continuing, provided that in no event will the Final Valuation Date be postponed by more than five Trading Days. 
 “Index Component” means, with respect to the Securities, any of the equity securities that comprise the Index. 
 “Index Factor” means, on any given day, the amount equal to the closing value of the Index on that day divided by the closing
value of the Index on the Inception Date. 
 “Investor Fee” means the amount equal to 0.89% per year times the
principal amount of the Holder’s Securities times the Index Factor, calculated on a daily basis in the following manner: (i) the Investor Fee on the Inception Date shall equal zero; and (ii) on each subsequent calendar day
until and including the Final Valuation Date or, in the case of Securities with respect to which the Holder has exercised its right of Early Redemption, the applicable Valuation Date, the Investor Fee will increase by an amount equal to 0.89%
times the principal amount of the Holder’s Securities times the Index Factor on that day (or, if such day is not a Trading Day, the Index Factor on the immediately preceding Trading Day) divided by 365. 
 “Market Disruption Event” means, with respect to the Securities, in the opinion of the Calculation Agent and determined in its sole
discretion: (i) a suspension, absence or material limitation of trading in a material number of Index Components; (ii) a suspension, absence or material limitation of trading in option or futures contracts relating to the Index or a
material number of Index Components in the primary market for those 

  

 (Face of Security continued on next page) 
 –5– 

 
contracts for more than two hours of trading or during the one-half hour before the close of trading in the relevant market; (iii) the Index is not
published; (iv) any other event, if the Calculation Agent determines in its sole discretion that the event materially interferes with the ability of Barclays Bank PLC or the ability of any affiliates of Barclays Bank PLC to unwind all or a
material portion of a hedge with respect to the Securities that Barclays Bank PLC or any of its affiliates have effected or may effect. The following events will not be Market Disruption Events: (a) a limitation on the hours or numbers of days
of trading on the National Stock Exchange of India, but only if the limitation results from an announced change in the regular business hours of that exchange; or (b) a decision to permanently discontinue trading in the option or futures
contracts relating to the Index or any Index Component. Moreover, for the purposes of this definition, an “absence” of trading in the primary market on which option or futures contracts related to the Index or any Index Component are
traded will not include any time when the primary market is itself closed for trading under ordinary circumstances. 
 “Maturity
Date” means December 18, 2036, provided that if such date is not a Business Day, the Maturity Date will be the next succeeding Business Day, provided, however, that if the fifth Business Day preceding December 18,
2036 does not qualify as the Final Valuation Date referred to above, then the Maturity Date will be the fifth Business Day following the Final Valuation Date; in all cases, with no penalty interest accruing or payable on such Maturity Date.

 “MSCI” means Morgan Stanley Capital International Inc. 
 “Qualified Financial Institution” means, at any time, a financial institution organized under the laws of any jurisdiction in the United
States of America or Europe that at such time has outstanding debt obligations with a stated maturity of one year or less from the date of issue and rated A-1 or higher by Standard & Poor’s, a division of The McGraw Hill Companies,
Inc., Ratings Group (or any successor) or P-1 or higher by Moody’s Investors Service, Inc. (or any successor) or, in either case, such other comparable rating, if any, then used by such rating agency. 
 “Redemption Charge” means the amount equal to 0.00125 times the amount equal to the principal amount of the Holder’s
Securities times the Index Factor on the applicable Valuation Date minus the Investor Fee on the applicable Valuation Date. 
 “Redemption Date” means the third Business Day following each Valuation Date other than the Final Valuation Date. The final Redemption Date shall be the third Business Day following such Valuation Date that is immediately
prior to the Final Valuation Date. 
 “Successor Index” means any substitute index approved by the Calculation Agent as a
Successor Index pursuant to Section 3 hereof. 
 “Trading Day” means a day on which (i) the value of the Index is
published by MSCI, (ii) trading is generally conducted on the New York Stock Exchange and (iii) trading is generally conducted on the National Stock Exchange of India, in each case as determined by the Calculation Agent in its sole
discretion. 
  

 (Face of Security continued on next page) 
 –6– 

 “Valuation Date” means each Thursday from December 28, 2006 to December 11,
2036, inclusive, or if such date is not a Trading Day, the next succeeding Trading Day; provided, however, that if the Calculation Agent determines that a Market Disruption Event occurs or is continuing on such date, the Valuation Date
will be the first following Trading Day on which the Calculation Agent determines that a Market Disruption Event does not occur and is not continuing, provided that in no event will any Valuation Date be postponed by more than five Trading
Days. 
  

 1. Promise
to Pay at Maturity or Upon Early Redemption 
 Barclays Bank PLC, a public limited company duly organized and existing under the laws of
England and Wales (herein called the “Company,” which term includes any successor Person under the Indenture hereinafter referred to), for value received, hereby promises to pay (or cause to be paid) to Cede & Co., as
nominee for The Depository Trust Company, or registered assigns, the amount as calculated and provided under (i) “Early Redemption” and elsewhere on the face this Security on the applicable Redemption Date, in the case of any
Securities in respect of the which the Holder exercises such Holder’s right to require the Company to redeem such Holder’s Securities prior to the Maturity Date, or (ii) “Payment at Maturity” and elsewhere on the face of
this Security on the Maturity Date, in the case of all other Securities. 
 2. Payment of Interest 
 The principal of this Security shall not bear interest. 
 3. Discontinuance or Modification of the Index or the Index License Agreement; Market Disruption Event 
 If MSCI discontinues publication of the Index or, despite continued publication of the Index, the Company’s right to use the Index is suspended or terminated, and MSCI or any other Person or entity publishes an index that the
Calculation Agent determines is comparable to the Index and approves as a Successor Index, then the Calculation Agent will determine the value of the Index on the applicable Valuation Date and the amount payable on the Maturity Date or any
Redemption Date by reference to such Successor Index. 
 If the Calculation Agent determines that the publication of the Index is
discontinued or that the Company has no right to use the Index and that there is no Successor Index, or that the closing value of the Index is not available because of a Market Disruption Event or for any other reason, on any Valuation Date, or if
for any other reason the Index is not available to the Company or the Calculation Agent on any Valuation Date, the Calculation Agent will determine the amount payable by a computation methodology that the Calculation Agent determines will as closely
as reasonably possible replicate the Index. 
 If the Calculation Agent determines that the Index, the Index Components or the method of
calculating the Index has been changed at any time in any respect, including, without limitation, any addition, deletion or substitution and any reweighting or rebalancing of Index Components, and whether the change is made by MSCI under its
existing policies or following a modification of those policies, is due to the publication of a Successor Index, is 

  

 (Face of Security continued on next page) 
 –7– 

 
due to events affecting one or more of the Index Components, or is due to any other reason, then the Calculation Agent will be permitted (but shall not be
required) to make such adjustments to the Index or method of calculating the Index as it believes are appropriate to ensure that the value of the Index used to determine the amount payable on the Maturity Date or upon Early Redemption is equitable.

 The Calculation Agent shall have the right to postpone a Valuation Date, and thus the determination of the value of the Index, if the
Calculation Agent determines that, on such Valuation Date, a Market Disruption Event occurs or is continuing in respect of the Index. If such a postponement occurs, the Calculation Agent shall determine the value of the Index by using the closing
value of the Index on the first Trading Day after that day on which no Market Disruption Event occurs or is continuing. In no event, however, may the Calculation Agent postpone a Valuation Date by more than five Trading Days. 
 In the event that a Valuation Date is postponed until the fifth Trading Day following the scheduled Valuation Date, but a Market Disruption Event occurs
and is continuing on such day, that day shall nevertheless be a Valuation Date, and the Calculation Agent shall determine the value of the Index on such day by a good faith estimate of the value of the Index that would have prevailed in the absence
of a Market Disruption Event. 
 The Calculation Agent shall have the right to make all determinations and adjustments with respect to the
Index in its sole discretion. 
 4. Payment at Maturity or Upon Early Redemption 
 The payment of this Security that becomes due and payable on the Maturity Date or on a Redemption Date, as the case may be, shall be the cash amount that
must be paid to redeem this Security as provided above under “Payment at Maturity” and “Early Redemption”, respectively. The payment of this Security that becomes due and payable upon acceleration of the Maturity Date hereof
after an Event of Default has occurred pursuant to the Indenture shall be the Default Amount. When the principal referred to in either of the two preceding sentences has been paid as provided herein (or such payment has been made available), the
principal of this Security shall be deemed to have been paid in full, whether or not this Security shall have been surrendered for payment or cancellation. References to the payment at maturity or upon early redemption of this Security on any day
shall be deemed to mean the payment of cash that is payable on such day as provided in this Security. Notwithstanding the foregoing, solely for the purpose of determining whether any consent, waiver, notice or other action to be given or taken by
Holders of Securities pursuant to the Indenture has been given or taken by Holders of Outstanding Securities in the requisite aggregate principal amount, the principal amount of this Security will be deemed to equal the Face Amount. This Security
shall cease to be Outstanding as provided in the definition of such term in the Indenture when the principal of this Security shall be deemed to have been paid in full as provided above. 
 5. Redemption Mechanics 
 Subject to
the minimum redemption amount provided under “Early Redemption”, the Holder may require the Company to redeem the Holder’s Securities on any Redemption Date during the term of the Securities provided that such Holder
(i) delivers a notice of redemption to the Company via electronic mail by no later than 11:00 a.m., New 

  

 (Face of Security continued on next page) 
 –8– 

 
York City time, on the Business Day prior to the applicable Valuation Date; (ii) delivers a signed confirmation of redemption to the Company via
facsimile by no later than 4:00 p.m., New York City time, on the same day (the receipt of which confirmation must be acknowledged by the Company or one its affiliates in order for such confirmation to be effective); (iii) instructs the
Holder’s DTC custodian to book a delivery versus payment trade with respect to the Holder’s Securities on the applicable Valuation Date at a price equal to the principal amount of the Holder’s Securities times the Index Factor
on the applicable Valuation Date minus the Investor Fee on the applicable Valuation Date, less the Redemption Charge, facing Barclays Capital DTC 5101; and (iv) causes the Holder’s DTC custodian to deliver the trade as booked
for settlement via DTC prior to 10:00 a.m., New York City time, on the applicable Redemption Date, which shall be the third Business Day following the applicable Valuation Date (other than the Final Valuation Date). The final Redemption Date shall
be the third Business Day following such Valuation Date that is immediately prior to the Final Valuation Date. 
 6. Role of Calculation
Agent 
 The Calculation Agent will be solely responsible for all determinations and calculations regarding the value of the Securities,
including at maturity or upon early redemption; Market Disruption Events; Business Days; Trading Days; the Investor Fee; the Default Amount; the closing value of the Index on the Inception Date and on any Valuation Date; the Maturity Date;
Redemption Dates; the amount payable on the Securities and all such other matters as may be specified elsewhere herein as matters to be determined by the Calculation Agent. The Calculation Agent shall make all such determinations and calculations in
its sole discretion, and absent manifest error, all determinations of the Calculation Agent shall be final and binding on the Company, the Holder and all other Persons having an interest in this Security, without liability on the part of the
Calculation Agent. 
 The Company shall take such action as shall be necessary to ensure that there is, at all relevant times, a financial
institution serving as the Calculation Agent hereunder. The Company may, in its sole discretion at any time and from time to time, upon written notice to the Trustee, but without notice to the Holder of this Security, terminate the appointment of
any Person serving as the Calculation Agent and appoint another Person (including any Affiliate of the Company) to serve as the Calculation Agent. Insofar as this Security provides for the Calculation Agent to determine the value of the Index on any
date or other information from any institution or other source, the Calculation Agent may do so from any source or sources of the kind contemplated or otherwise permitted hereby notwithstanding that any one or more of such sources are the
Calculation Agent, Affiliates of the Calculation Agent or Affiliates of the Company. 
 7. Tax Characterization 
 By its purchase of this Security, the Holder, on behalf of itself and any other Person having a beneficial interest in this Security, hereby agrees with
the Company (in the absence of an administrative determination or judicial ruling to the contrary) to characterize this Security for all U.S. federal income tax purposes as a pre-paid contract with respect to the Index. 
  

 (Face of Security continued on next page) 
 –9– 

 8. Payment 
 Payment of any amount payable 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. Payment will be
made to an account designated by the Holder (in writing to the Company and the Trustee on or before the applicable Valuation Date) and acceptable to the Company or, if no such account is designated and acceptable as aforesaid, at the office or
agency of the Company maintained for that purpose in The City of New York, provided, however, that payment on the Maturity Date or any Redemption Date shall be made only upon surrender of this Security at such office or agency
(unless the Company waives surrender). Notwithstanding the foregoing, if this Security is a Global Security, any payment may be made pursuant to the Applicable Procedures of the Depositary as permitted in said Indenture. 
 9. Reverse of this Security 
 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. 
 10. Certificate of Authentication 
 Unless the certificate of authentication hereon has been executed by the Trustee 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. 
  

 (Face of Security continued on next page) 
 –10– 

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

			
	BARCLAYS BANK PLC
		
	By:	 	  
		 	Name:
		 	Title:

  

			
		
	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
		
	By:	 	  
		 	Name:
		 	Title:

  

 (Face of Security continued on next page) 
 –11– 

 (Reverse of Security) 
 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
September 16, 2004 (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, 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 the Securities and of the terms upon which the Securities are, and are to be, authenticated and delivered. Insofar as the provisions of the Indenture may conflict with the provisions set forth on the face of this Security, the latter shall
control for purposes of this Security. 
 This Security is one of the series designated on the face hereof, limited to an aggregate initial offering price
not to exceed $10,000,000,000 (or the equivalent thereof in any other currency or currencies or currency units), which amount may be increased at the option of the Company if in the future it determines that it may wish to sell additional Securities
of this series. References herein to “this series” mean the series designated on the face hereof. 
 Payments under the Securities will be
made without deduction or withholding for, or on account of, any and all present or future income, stamp and other taxes, levies, imposts, duties, charges, fees, deductions or withholdings (“Taxes”) now or hereafter imposed, levied,
collected, withheld or assessed by or on behalf of the United Kingdom or any political subdivision or authority thereof or therein having the power to tax (each a “Taxing Jurisdiction”), unless such deduction or withholding is
required by law. If any such Taxes are at any time required by a Taxing Jurisdiction to be deducted or withheld, the Company will, subject to the exceptions and limitations set forth in Section 10.04 of the Indenture, pay such additional
amounts of the principal of such Security and any other amounts payable on such Security (“Additional Amounts”) as may be necessary in order that the net amounts paid to the Holder of any Security, after such deduction or
withholding, shall equal the amounts of the principal of such Security and any other amounts payable on such Security which would have been payable in respect of such Security had no such deduction or withholding been required. 
 If at any time the Company determines that as a result of a change in or amendment to the laws or regulations of a Taxing Jurisdiction (including any treaty to which
such Taxing Jurisdiction is a party), or a change in an official application or interpretation of such laws or regulations (including a decision of any court or tribunal), either generally or in relation to any particular Securities, which change,
amendment, application or interpretation becomes effective on or after the Original Issue Date in making any payment of, or in respect of, the principal amount of the Securities, the Company would be required to pay any Additional Amounts with
respect thereto, then the Securities will be redeemable upon not less than 35 nor more than 60 days’ notice by mail, at any time thereafter, in whole but not in part, at the election of the 

  

 (Face of Security continued on next page) 
 –12– 

 
Company as provided in the Indenture at a redemption price equal to the principal amount thereof. 
 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 aggregate 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 aggregate principal amount of the Securities at the 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. 
 As provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have any right to institute any proceeding, judicial or otherwise, 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 aggregate 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
reasonable indemnity against the costs, expenses and liabilities to be incurred in compliance with such request, 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 hereof on or after the respective due dates expressed herein. 
  

 (Face of Security continued on next page) 
 –13– 

 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 this Security as herein provided. 
 As provided in the Indenture and
subject to certain limitations therein set forth, the transfer of this Security is registrable in the Senior Debt 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 this Security is payable, duly endorsed by, or accompanied by a written instrument of transfer in form satisfactory to the Company and the Senior Debt Security Registrar duly executed by, the Holder hereof or his attorney duly
authorized in writing. 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. 
 This Security, and any other Securities of this series and of like tenor, are issuable only in registered form without coupons in denominations of any multiple of $50.
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 and the Indenture shall be
governed by and construed in accordance with the laws of the State of New York. 
  

 (Face of Security continued on next page) 
 –14–EXHIBIT 10.20

 Exhibit 10.20 
 AMENDMENT NO. 3 TO 
 THE REVOLVING CREDIT AGREEMENT 
 AMENDMENT NO. 3 TO THE REVOLVING CREDIT AGREEMENT dated as of December 14, 2006 (this “Amendment”) among MSC-Medical
Services Company, a Florida corporation (the “Borrower”), MCP-MSC Acquisition, Inc., a Delaware corporation (“Holdings”), the banks, financial institutions and other lenders party hereto (collectively, the
“Lenders”) and Bank of America, N.A. (“Bank of America”), as administrative agent (in such capacity, the “Administrative Agent”) for the Lenders. 
 PRELIMINARY STATEMENTS: 
 (1) The
Borrower, the Guarantors, the Administrative Agent, the Lenders and Bank of America, as L/C Issuer, have entered into a Revolving Credit Agreement dated as of March 31, 2005, as amended by Amendment No. 1 to the Revolving Credit
Agreement dated as of May 12, 2005 and Amendment No. 2 to the Revolving Credit Agreement dated as of December 9, 2005 (the “Credit Agreement”). Capitalized terms not otherwise defined in this Amendment have the
same meanings as specified in the Credit Agreement. 
 (2) The Borrower, the Administrative Agent and the Lenders have agreed to amend the
Credit Agreement in certain respects as set forth below. 
 SECTION 1. Amendments to Credit Agreement . Upon, and subject to, the
satisfaction of the conditions precedent set forth in Section 2 hereof, the Credit Agreement is hereby amended, as follows: 
 (a)
Section 1.01 is amended by inserting in the appropriate alphabetical order the following definitions: 
 “Calculation
Period” means, with respect to the calculation of the Consolidated Fixed Charge Coverage Ratio for purposes of satisfying the Transaction Conditions, the most recently completed Measurement Period for which a Compliance Certificate has been
delivered pursuant to Section 6.02(b); provided that if such calculation occurs (A) prior to the delivery of a Compliance Certificate in respect of the most recently completed Measurement Period or (B) more than one
month after the end of the most recently completed Measurement Period, “Calculation Period” shall mean, at the Borrower’s option, either (i) the most recently completed Measurement Period for which a Compliance Certificate
has been delivered pursuant to Section 6.02(b) or (ii) a 12 month period (the “Test Period”) ending on the last day of either of the two calendar months preceding such calculation to the extent that the Borrower
provides the Administrative Agent with (a) financial statements meeting the requirements of Section 6.01(b) for the period commencing with the first day following the last Measurement Period for which a Compliance Certificate has
been delivered and ending on the last day of the Test Period and (B) a Compliance Certificate in respect of such Test Period. 
 “Capital Expenditure Carryover Amount” has the meaning specified in Section 7.19. 
 Amendment No. 3 to
MSC Revolving Credit Agreement 

 “Restricted Transaction” means (a) the incurrence of any Permitted Holdco Debt
pursuant to Section 7.02(h), (b) the making of any Investment pursuant to Section 7.03(h), 7.03(i) or 7.03(k)(i), (c) the making of any Restricted Payment pursuant to Section 7.06(d)(i) or
7.06(g), (d) any redemption, purchase or prepayment of Holdco Senior Discount Notes pursuant to Section 7.14(d) and (e) the determination of whether the Borrower is entitled to any Capital Expenditure Carryover Amount
pursuant to Section 7.19. 
 “Suspension Consolidated Fixed Charge Coverage Ratio” means, for any consecutive
twelve month period, as of any date of determination, the ratio of (but without duplication) (a) Consolidated EBITDA minus (i) Capital Expenditures minus (ii) Federal, state, local and foreign income or franchise taxes
paid or required to be paid in cash minus (iii) the aggregate amount attributable to any Restricted Transaction (excluding any such amount to the extent included in clause (b) hereof) consummated during such period to
(b) the sum of (i) Consolidated Cash Interest Charges plus (ii) the aggregate amount of scheduled payments and redemptions, repurchases, prepayments and similar acquisitions for value in respect of, all Consolidated
repurchases, prepayments and similar acquisitions for value in respect of, all Consolidated Funded Indebtedness, but excluding payments on the Revolving Credit Loans not accompanied by a corresponding reduction of the Commitments under the Revolving
Credit Facility and any such redemptions, repurchases, prepayments and similar acquisitions to the extent refinanced through the incurrence of additional Indebtedness otherwise expressly permitted under Section 7.02. 
 “Suspension Date” means the first date following the consummation of a Restricted Transaction on which the Suspension Consolidated Fixed
Charge Coverage Ratio for the consecutive twelve month period ending with the month for which financial statements have most recently been delivered pursuant to Section 6.01(c), is no less than 1.00:1.00. 
 “Transaction Conditions” means, with respect to any Restricted Transaction, the satisfaction at the time of the consummation of such
Restricted Transaction of the following conditions: (a) no Default shall exist, or would result from the consummation of such Restricted Transaction; (b) the Consolidated Fixed Charge Coverage Ratio for the most recently completed
Calculation Period ending prior to such Restricted Transaction, after giving pro forma effect to such Restricted Transaction and to any other Restricted Transaction occurring after such Calculation Period as if such Restricted Transaction had
occurred as of the first day of such Calculation Period shall be not less than (i) prior to March 31, 2008: (A) with respect to the determination of whether the Borrower is entitled to any Capital Expenditure Carryover Amount,
1.25:1.00 and (B) with respect to any other Restricted Transaction, 1.00:1.00, (ii) on and after March 31, 2008 but prior to June 30, 2008: (A) with respect to the determination of whether the Borrower is entitled to any
Capital Expenditure Carryover Amount, 1.25:1.00 and (B) with respect to any other Restricted Transaction, 1.10:1.00, (iii) on and after June 30, 2008 but prior to September 30, 2008: (A) with respect to the determination of
whether the Borrower is entitled to any Capital Expenditure Carryover Amount, 1.25:1.00 and (B) with respect to any other Restricted Transaction, 1.20:1.00 and (iv) on and after September 30, 2008 , 1.25:1.00; and (c) solely with
respect to any Restricted Transaction contemplated by clauses (a) through (d) of the 
 Amendment No. 3 to MSC
Revolving Credit Agreement 
  

 2 

 
definition thereof, the Borrowing Availability shall be at least $5,000,000 both before and after giving effect to such Restricted Transaction. 

(b) Section 1.01 is further amended as follows: 
 (i) The definition of “Consolidated EBITDA” is amended and restated in its entirety as follows: 
 “Consolidated EBITDA” means, at any date of determination, an amount equal to Consolidated Net Income of the Borrower and its
Subsidiaries for the most recently completed Measurement Period plus the following to the extent deducted in calculating, or otherwise reducing, such Consolidated Net Income, without duplication: (a) Consolidated Interest Charges,
(b) the provision for Federal, state, local and foreign income or franchise taxes payable, (c) depreciation and amortization expense and (d) any non-cash charges relating to the impairment of goodwill not to exceed $125,000,000 in the
aggregate for fiscal years 2006 and 2007. 
 (ii) The definition of “Consolidated Fixed Charge Coverage
Ratio” is amended and restated in its entirety as follows: 
 “Consolidated Fixed Charge Coverage Ratio” means, for
any Measurement Period, as of any date of determination, the ratio of (a) Consolidated EBITDA to (b) the sum of (i) Consolidated Cash Interest Charges plus (ii) the aggregate amount of scheduled payments and redemptions,
repurchases, prepayments and similar acquisitions for value in respect of, all Consolidated Funded Indebtedness, but excluding payments on the Revolving Credit Loans not accompanied by a corresponding reduction of the Commitments under the Revolving
Credit Facility and any such redemptions, repurchases, prepayments and similar acquisitions to the extent refinanced through the incurrence of additional Indebtedness otherwise expressly permitted under Section 7.02. 
 (c) The first sentence of Section 5.11 is amended and restated in its entirety as follows: 
 The Borrower and its Subsidiaries have filed all Federal, state and other material tax returns and reports required to be filed, and have paid all
Federal, state and other material taxes, assessments, fees and other governmental charges levied or imposed upon them or their properties, income or assets otherwise due and payable, except (a) as set forth on Schedule 5.11,
(b) certain sales tax payable by the Borrower and its Subsidiaries for any period prior to December 14, 2006 in an aggregate amount of not more than $3,530,000 as to which the Borrower and its Subsidiaries are currently engaged in good
faith settlement negotiations with the relevant state or local authority (or have filed voluntary disclosure requests or sales and use tax agreements) and for which the Borrower and its Subsidiaries have established adequate reserves in accordance
with GAAP and (c) such other taxes, assessments, fees or charges as are being contested in good faith by appropriate action diligently conducted and for which adequate reserves have been provided in accordance with GAAP. 
 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 3 

 (d) Section 6.01 shall be amended by inserting a new subsection (e) following the
end of subsection (d) thereto as follows: 
 (e) On or prior to the tenth Business Day following each month commencing with the
month ending December 31, 2006, (i) forecasts, prepared by management of the Borrower, in form satisfactory to the Administrative Agent, of Consolidated statements of cash flows on a weekly basis for the subsequent 13 week period
(including cash receipts and disbursements) for the Borrower and its Subsidiaries and (ii) Consolidated statements of cash flows (including cash receipts and disbursements) for the Borrower and its Subsidiaries for the immediately preceding 13
week period, setting forth, to the extent available based on forecasts delivered previously delivered pursuant to clause (i) above, in comparative form actual cash flow and planned cash flow for such 13 week period. 
 (e) Section 6.01 shall be further amended by inserting a new subsection (f) following the end of subsection
(e) thereto as follows: 
 (f) As soon as available, but in any event within 45 days after the end of each fiscal quarter of the
Borrower, a Pay Report. 
 (f) Section 6.04(a) is hereby amended and restated in its entirety as follows: 
 (a) all tax liabilities, assessments and governmental charges or levies upon it or its properties or assets, unless (i) the same are being contested
in good faith by appropriate proceedings diligently conducted and adequate reserves in accordance with GAAP are being maintained by the Borrower or such Subsidiary or (ii) with respect to sales tax payable by the Borrower and its Subsidiaries
for any period prior to December 14, 2006 in an aggregate amount of not more than $3,530,000, the Borrower and its Subsidiaries are engaged in good faith settlement negotiations in respect of the payment of such sales tax with the relevant
state or local authority, or are filing or have filed voluntary disclosure requests or sales and use tax agreements and have established adequate reserves in accordance with GAAP; 
 (g) Article VI shall be amended by inserting a new Section 6.20 after the end of Section 6.19, as follows: 
 Section 6.20. Restricted Transactions. Upon the consummation of any Restricted Transaction and at all times thereafter until the Suspension
Date, the Borrower shall maintain a Borrowing Availability of not less than $5,000,000. 
 (h) Section 7.02(h) is hereby amended
by inserting “(I)” immediately after the words “provided, further” and further inserting the words “and (II) with respect to any Permitted Holdco Debt incurred after December 14, 2006, the Transaction Conditions
are met” immediately after the words “in the aggregate” and before “; and”. 
 (i) Section 7.03(h)(v) is
hereby amended by (i) replacing the word “and” with “;”immediately prior to “(B)” and (ii) further inserting the words “and (C) with respect to any Investment 
 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 4 

 
made pursuant to this Section 7.03(h) after December 14, 2006, the Transaction Conditions are met” immediately after the words
“fiscal period covered thereby” and before “; and”. 
 (j) Section 7.03(i) is hereby amended and restated in
its entirety as follows: 
 at any time after December 1, 2007, so long as the applicable Transaction Conditions are met, other
Investments by the Borrower and its Subsidiaries not exceeding in the aggregate (i) prior to the Bridge Covenant Release, $1,000,000, and (ii) thereafter, $2,500,000; 
 (k) Section 7.03(k)(i) is hereby amended and restated in its entirety as follows: 
 (i) at any time after December 1, 2007, so long as the Transaction Conditions are met, any accrued interest in respect of any Permitted Holdco Debt
and any Permanent Financing issued by Holdings, in each case, incurred in accordance with the terms hereof and required to be paid in cash pursuant to the terms thereof so long as such Investment is made five days prior to the required date for such
payment, 
 (l) Section 7.06 is amended by deleting the “.” at the end of clause (g) and inserting the
following “:” and adding the following proviso to Section 7.06: “provided that notwithstanding anything in this Section 7.06 to the contrary, in no event shall the Borrower or Holdings make any payment
in respect of, or redeem or defease any Permitted Holdco Debt prior to December 1, 2007. 
 (m) Section 7.06(d)(i) is hereby
amended and restated in its entirety as follows: 
 (i) at any time after December 1, 2007, so long as the Transaction Conditions are
met, any accrued interest in respect of any Permitted Holdco Debt and any Permanent Financing issued by Holdings, in each case, incurred in accordance with the terms hereof and required to be paid in cash pursuant to the terms thereof so long as
such Restricted Payment is made five days prior to the required date for such payment, 
 (n) Section 7.06(g) is hereby amended
and restated in its entirety as follows: 
 at any time after December 1, 2007, so long as the Transaction Conditions are met and after
the Bridge Covenant Release, the Borrower may make dividend payments and distributions to Holdings in an amount not to exceed $1,000,000 in any fiscal year (any portion of which, if not paid in the fiscal year for which it is permitted, may be
carried over for payment in the next following two successive fiscal years and dividend payments and distributions in successive years shall be deemed to have been made first from the annual basket and only thereafter from any carried-over amounts)
to permit Holdings to make Restricted Payments (which shall include payments in respect of Indebtedness permitted under Section 7.02(i)) not otherwise permitted under this Section 7.06 substantially concurrently with such
payments and distributions. 
 (o) Section 7.11(a) is amended and restated in its entirety as follows: 
 (a) Consolidated Fixed Charge Coverage Ratio. Permit the Consolidated Fixed Charge Coverage Ratio at any time during any period of four fiscal

 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 5 

 quarters of the Borrower set forth below to be less than the ratio set forth below opposite such period:

  

			
	 Four Fiscal Quarters Ending
	  	Consolidated Fixed
Charge Coverage
Ratio
	 September 30, 2006
	  	0.90:1.00
	 December 31, 2006
	  	0.90:1.00
	 March 31, 2007
	  	0.90:1.00
	 June 30, 2007
	  	0.90:1.00
	 September 30, 2007
	  	0.90:1.00
	 December 31, 2007
	  	1.00:1.00
	 March 31, 2008
	  	1.10:1.00
	 June 30, 3008
	  	1.20:1.00
	 September 30, 2008 and each fiscal quarter thereafter
	  	1.25:1.00

 (p) Section 7.14(d) is amended and restated in its entirety as follows: 
 (d) so long as the Transaction Conditions are met, the redemption, purchase or prepayment of Holdco Senior Discount Notes originally issued and then still
outstanding (including any notes issued in respect of interest accrued thereon), the proceeds of which were applied to prepay amounts outstanding under the Bridge Facility (and related costs and expenses), at any time after the date that is 30 days
prior to the 5 year anniversary of the issuance thereof but no earlier than ten days prior to the required date of the payment therefor solely to the extent that such redemption, purchase or prepayment (i) is required to avoid the
characterization of the Holdco Senior Discount Note Indenture as “applicable high yield discount obligations” within the meaning of Section 163(i)(I) of the Code, or (ii) would reduce the disallowed amount of interest deductions
or the disqualified portion of the original issue discount with respect to the Holdco Senior Discount Notes under Section 163(e)(5) of the Code. 
 (q) Article VII shall be amended by inserting a new Section 7.19 after the end of Section 7.18, as follows: 
 Section 7.19. Capital Expenditures. Make or become legally obligated to make any Capital Expenditure in the fiscal year ending December 31, 2006 or any fiscal year thereafter during the term of
this Agreement, except for Capital Expenditures in the ordinary course of business not exceeding, in the aggregate for the Borrower and its Subsidiaries during 
 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 6 

 each fiscal year set forth below, the amount set forth opposite such fiscal year: 
  

				
	 Fiscal Year
	  	Amount
	 2006
	  	$	5,500,000
	 2007
	  	$	6,500,000
	 2008
	  	$	5,000,000
	 2009
	  	$	5,000,000
	 2010
	  	$	5,000,000

 ; provided, however, that up to $2,500,000 of any amount set forth above in respect
of the fiscal years commencing with fiscal year 2007, if not expended in the fiscal year for which it is permitted above, may be carried over for expenditure in the next following fiscal year (the “Capital Expenditure Carryover
Amount”); provided further that at the time of the making of any Capital Expenditure from the Capital Expenditure Carryover Amount, the Transaction Conditions are met. 
 (r) Section 8.01(b) shall be amended by inserting immediately prior to the words “or Article VII” the following: “,
6.20”. 
 (s) Exhibit C is amended and restated in its entirety as set forth in Exhibit C hereto. 
 (t) A new Exhibit L is added to the Credit Agreement in the form attached hereto as Exhibit K and the Table of Contents is amended to
insert at the end of the list of Exhibits, “Exhibit L – Form of Pay Report”. 
 SECTION 2. Conditions of
Effectiveness. The amendments set forth in Section 1 shall become effective when, and only when, and as of the date on which each of the following conditions shall have been satisfied: 
 (a) the Administrative Agent shall have received counterparts of this Amendment executed by the Borrower, Holdings and the Required Lenders, and dated the
date of receipt thereof by the Administrative Agent (unless otherwise specified); 
 (b) The Administrative Agent shall have received an
amendment fee for the account of each Lender approving this Amendment on or before 3:00 p.m. (New York time) December 14, 2006 in an amount equal to 0.50% of the aggregate amount of each such Lender’s Commitment; 
 (c) the Administrative Agent shall have received payment of all accrued expenses of the Administrative Agent (including the reasonable and accrued fees
of counsel to the Administrative Agent invoiced on or prior to the date hereof); and 
 Amendment No. 3 to MSC Revolving Credit Agreement

  

 7 

 (d) immediately after giving effect to the amendments set forth in Section 1, (i) no
Default shall have occurred and be continuing, and (ii) the representations and warranties of the Borrower and each other Loan Party contained in Article V of the Credit Agreement and any other Loan Document, or which are contained in
any document furnished at any time under or in connection herewith or therewith, shall be true and correct in all material respects on and as of the date of such issuance, except to the extent that such representations and warranties specifically
refer to an earlier date, in which case they shall be true and correct in all material respects as of such earlier date. 
 SECTION 3.
Representations, Etc. The Borrower hereby represents and warrants that, after giving effect to the amendments set forth in Section 1 hereof, no Default or Event of Default has occurred and is continuing under the Credit Agreement.

 SECTION 4. Release of Claims. Each of Holdings and the Borrower hereby acknowledges and agrees that it does not have any defenses,
counterclaims, offsets, cross-complaints, claims or demands of any kind or nature whatsoever that can be asserted to reduce or eliminate all or any part of the obligation of any Loan Party to pay any amounts owed in respect of any Loans under the
Credit Agreement or any other amounts owed under any other Loan Document, or to seek affirmative relief or damages of any kind or nature from any of the Administrative Agents, the Lenders and the L/C Issuer (each a “Lender Party”).
Each of Holdings and the Borrower hereby voluntarily and knowingly releases and forever discharges each Lender Party and each of its Affiliates, officers, employees, agents, representatives, successors and assigns (each, a “Lender Related
Person”), from all possible claims, actions, demands, causes of action, damages, costs, or expenses, and liabilities whatsoever, known or unknown, anticipated or unanticipated, suspected or unsuspected, fixed, contingent, or conditional, at
law or in equity, originating in whole or in part on or before the date hereof, which each or any Loan Party may have against any Lender Party or Lender Related Person, if any, relating to the Credit Agreement, any other Loan Document or any other
document or agreement relating thereto, or the negotiation and execution of this Amendment, including, without limitation, the administration of, or the taking or failure to take of any actions under, any of the foregoing, and irrespective of
whether any such claims, actions, demands, causes of action, damages, costs, or expenses, and liabilities arise out of contract, tort, violation of law or regulations, or otherwise. 
 SECTION 5. Reference to and Effect on the Loan Documents. (a) On and after the effectiveness of this Amendment, each reference in the Credit
Agreement to “this Agreement”, “hereunder”, “hereof” or words of like import referring to the Credit Agreement, and each reference in the Notes and each of the other Loan Documents to “the
Credit Agreement”, “thereunder”, “thereof” or words of like import referring to the Credit Agreement, shall mean and be a reference to the Credit Agreement, as amended by this Amendment. 
 (b) The Credit Agreement, the Notes and each of the other Loan Documents, as specifically amended by this Amendment, are and shall continue to be in full
force and effect and are hereby in all respects ratified and confirmed. Without limiting the generality of the foregoing, the Collateral Documents and all of the Collateral described therein do and shall continue to secure the payment of all
Obligations of the Loan Parties under the Loan Documents, in each case as amended by this Amendment. 
 (c) The execution, delivery and
effectiveness of this Amendment shall not, except as expressly provided herein, operate as a waiver of any right, power or remedy of any Lender or the Administrative Agent under any of the Loan Documents, nor constitute a waiver of any provision of
any of the Loan Documents. 
 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 8 

 SECTION 6. Consent. Holdings, as a Guarantor under the Credit Agreement in favor of the
Administrative Agent and the Lenders party to the Credit Agreement, hereby consents to this Amendment and hereby confirms and agrees that (a) notwithstanding the effectiveness of such Amendment, the Guaranty made by Holdings in favor of the
Secured Parties under Article X of the Credit Agreement is, and shall continue to be, in full force and effect and is hereby ratified and confirmed in all respects and (b) each of the Collateral Documents to which such Guarantor is a
party and all of the Collateral described therein do, and shall continue to, secure the payment of all of the obligations to be secured thereunder. 
 SECTION 7. Costs, Expenses. The Borrower agrees to pay on demand all reasonable costs and expenses of the Administrative Agent in connection with the preparation, execution, delivery and administration, modification and amendment of
this Amendment and the other instruments and documents to be delivered hereunder (including, without limitation, the reasonable fees and expenses of counsel for the Administrative Agent) in accordance with the terms of Section 11.04 of
the Credit Agreement. 
 SECTION 8. Execution in Counterparts. This Amendment may be executed in any number of counterparts and by
different parties hereto in separate counterparts, each of which when so executed shall be deemed to be an original and all of which taken together shall constitute but one and the same agreement. Delivery of an executed counterpart of a signature
page to this Amendment by telecopier shall be effective as delivery of a manually executed counterpart of this Amendment. 
 SECTION 9.
Governing Law. This Amendment shall be governed by, and construed in accordance with, the laws of the State of New York. 
 [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] 
 Amendment No. 3 to MSC Revolving Credit Agreement 
  

 9 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their respective
officers thereunto duly authorized, as of the date first above written. 
  

					
	MSC-MEDICAL SERVICES COMPANY
		
	By	 	 /s/ Gary Jensen

		 	Name: Gary Jensen
		 	Title: Chief Financial officer
	
	MCP-MSC ACQUISITION, INC.
		
	By	 	 /s/ Gary Jensen

		 	Name: Gary Jensen
		 	Title: Chief Financial officer

  

 Amendment No. 3 to MSC Revolving Credit Agreement 

			
	BANK OF AMERICA, N.A., as Administrative Agent and as a Lender
		
	By	 	 /s/ Kevin M. Behan

		 	Name: Kevin M. Behan
		 	Title: Senior Vice President

  

 Amendment No. 3 to MSC Revolving Credit Agreement 

			
	Other Lenders:
	
	 Carolina First Bank

		
	By	 	 /s/ Charles D. Chamberlain

		 	Name: Charles D. Chamberlain
		 	Title: Executive Vice President

 Amendment No. 3 to MSC Revolving Credit Agreement 

			
	Other Lenders:
	
	General Electric Capital Corp.
		
	 By
	 	 /s/ Jeffrey Thomas

		 	Name: JEFFREY THOMAS
		 	Title: Duly Authorized Signatory

 Amendment No. 3 to MSC Revolving Credit Agreement 

 EXHIBIT C 
 FORM OF COMPLIANCE CERTIFICATE 
 COMPLIANCE CERTIFICATE 
 Financial Statement Date:
                        , 
  

	To:	Bank of America, N.A., as Administrative Agent 

 100 Federal Street 
 MA5-100-11-02 
 Boston, MA 02110 
 Attention: William Faidell 
 Office of Agency Management 
 Telephone: (617) 434-2456 
 Telecopy: (617) 790-1358 
 Email: william.j.faidell@bankofamerica.com 
 Ladies and Gentlemen: 
 Reference is made to that certain
Revolving Credit Agreement, dated as of March 31, 2005 (as amended, restated, extended, supplemented or otherwise modified in writing from time to time, the “Agreement”), among MSC-Medical Services Company, a Florida
corporation (as survivor of the Merger, the “Borrower”), MCP-MSC Acquisition, Inc., a Delaware corporation, the Lenders from time to time party thereto and Bank of America, N.A., as Administrative Agent and L/C Issuer. Capitalized
terms used herein and not defined herein shall have the meanings therefor specified in the Agreement. 
 The undersigned Responsible Officer
hereby certifies as of the date hereof that he/she is the Chief Financial Officer of the Borrower, and that, as such, he/she is authorized to execute and deliver this Certificate to the Administrative Agent on behalf of the Borrower, and that:

 [Use following paragraph 1 for fiscal year-end financial statements] 
 1. Attached hereto as Schedule 1 are the year-end audited financial statements required by Section 6.01(a) of the Agreement for the
fiscal year of the Borrower ended as of the above date, together with the report and opinion of an independent certified public accountant required by such Section. Such consolidated financial statements fairly present the financial condition
of the Borrower and its Subsidiaries as of the date thereof and their results of operations for the period covered thereby in accordance with GAAP consistently applied throughout the period covered thereby, except as otherwise expressly noted
therein, and show all material indebtedness and other liabilities, direct or contingent, of the Borrower and its Subsidiaries as of the date thereof, including liabilities for taxes, material commitments and Indebtedness which in accordance with
GAAP are required to be shown in the financial statements or notes thereto. 
 [Use following paragraph 1 for fiscal quarter-end financial
statements] 
 1. Attached hereto as Schedule 1 are the unaudited financial statements required by Section 6.01(b) of
the Agreement for the fiscal quarter of the Borrower ended as of the above date. Such consolidated financial statements fairly present in all material respects the financial condition, results of 
  

 MSC - Compliance Certificate 

 
operations, shareholders’ equity and cash flows of the Borrower and its Subsidiaries in accordance with GAAP as of such date and their results of
operations for the period covered thereby, subject only to normal year-end audit adjustments and the absence of footnotes. 
 2. The
undersigned has reviewed and is familiar with the terms of the Agreement and the other Loan Documents and has made, or has caused to be made under [his/her] supervision, a detailed review of the transactions and condition (financial or otherwise) of
the Borrower during the accounting period covered by the attached financial statements. 
 3. A review of the activities of the Borrower
during such fiscal period has been made under the supervision of the undersigned, and 
 [select one:] 
 [to the best knowledge of the undersigned during such fiscal period, the Borrower and the other Loan Parties performed and observed each covenant and
condition of the Loan Documents applicable to it, and no Default has occurred and is continuing.] 
 —or— 

[the following covenants or conditions have not been performed or observed and the following is a list of each such Default and its nature and
status:] 
 4. The representations and warranties of the Borrower and each other Loan Party contained in Article V and any
other Loan Document, or which are contained in any document furnished at any time under or in connection herewith or therewith, are true and correct in all material respects on and as of the date hereof [except as set forth in
paragraph 3 above, and] except (a) to the extent that such representations and warranties specifically refer to an earlier date, in which case they shall be true and correct in all material respects as of such earlier date,
(b) for purposes of this Compliance Certificate, the representations and warranties contained in Sections 5.05(a) and (b) of the Agreement shall be deemed to refer to the most recent statements furnished pursuant to
Sections 6.01(a) and (b) of the Agreement, respectively, including the statements in connection with which this Compliance Certificate is delivered and (c) references to the Schedules in Article V of the
Agreement shall be deemed to refer to such Schedules as amended pursuant to Section 6.02(j) of the Agreement, without regard to any interim developments since the date of delivery of the most recent quarterly update to such
Schedules pursuant to such Section. 
 5. The financial covenant analyses and information set forth on Schedule 2
attached hereto are true and accurate on and as of the date of this Certificate. 
 6. Attached hereto as Schedule 3 are (a) the
supplements to Schedules [5.08], [5.13][5.17] to the Agreement delivered herewith pursuant to Section 6.02(j) of the Agreement and (b) the supplements to the Schedules to the Security Agreement delivered herewith
pursuant to Section 9(c) to the Security Agreement. 
 IN WITNESS WHEREOF, the undersigned has executed this Certificate
as of                     , 20    . 
  

 MSC - Compliance Certificate 

			
	MSC-Medical Services Company
		
	By:	 	  

	Name:	 	  

	Title:	 	Chief Financial Officer

  

 MSC - Compliance Certificate 

 SCHEDULE 2 
 to the Compliance Certificate 
 ($ in 000’s) 
 For the Quarter/Year ended                      (“Statement Date”)

  

					
	I.	  	Consolidated EBITDA for the Measurement Period ending on the Statement Date1:	 	
			
		  	 A.     Consolidated Net Income for such Measurement Period:
	 	$            
			
		  	 B.     To the extent deducted in calculating, or otherwise reducing Consolidated Net Income for such Measurement
Period:
	 	
			
		  	 1.      Consolidated Interest Charges:
	 	$            
			
		  	 2.      Income and franchise taxes:
	 	$            
			
		  	 3.      Depreciation expenses:
	 	$            
			
		  	 4.      Amortization expenses:
	 	$            
			
		  	 5.      For fiscal year 2006, non-cash charges relating to the impairment of goodwill not to exceed $125,000,000
in the aggregate for fiscal years 2006 and 2007
	 	$            
			
	.	  	 C.     Consolidated EBITDA: Line I.A. plus the sum of Line I.B.1. through Line I.B.4:
	 	$            
			
	II.	  	Section 7.11(a) - Consolidated Fixed Charge Coverage Ratio for the Measurement Period ending on the Statement Date2:	 	
			
		  	 A.     Consolidated EBITDA as set forth in Line I.C:
	 	$            
			
		  	 B.     Consolidated Cash Interest Charges
	 	$            

  

	1	For the fiscal quarter ending June 30, 2005, Consolidated EBITDA shall be calculated based on the December 31, 2004, March 31, 2005 and
June 30, 2005 fiscal quarters multiplied by 4/3. 

	2	Consolidated Cash Interest Charges shall be calculated during the first three full and complete fiscal quarters completed after the Closing Date by
multiplying (i) for the first such complete fiscal quarter, by 4 the Consolidated Cash Interest Charges for such complete fiscal quarter, (ii) for the second such complete fiscal quarter, by 2 the Consolidated Cash
Interest Charges for the first two such complete fiscal quarters, and (iii) for the third such complete fiscal quarter, by 4/3 the Consolidated Cash Interest Charges for the first three such complete fiscal quarters and (c) if the
Closing Date occurs after March 31, 2005, Consolidated Cash Interest Charges for the fiscal quarter ending June 30, 2005 shall be calculated by multiplying by 4 the pro forma Consolidated Cash Interest Charges for
such fiscal quarter determined as if the total Indebtedness reflected on the consolidated balance sheet for the fiscal quarter ended June 30, 2005 had been incurred on the first day of such fiscal quarter (and remained outstanding without
any increase or decrease in the amount of such Indebtedness during such fiscal quarter) at the applicable interest rates with respect thereto on June 30, 2005 (without considering any increase or decrease in such interest rates during such
fiscal quarters). 

  

 MSC – Compliance Certificate 

					
		  	 C.     Payments, redemptions, repurchases and similar acquisitions for value in respect of all Consolidated Funded
Indebtedness, (whether scheduled, mandatory or required at the option of the holders thereof), excluding (x) payments in respect of the Revolving Credit Loans not accompanied by a corresponding reduction of the Commitments, and (y) any payments,
redemptions, repurchases and acquisitions to the extent refinanced through the incurrence of additional Indebtedness otherwise expressly permitted under Section 7.02
	  	$            
			
		  	 D.     Consolidated Fixed Charge Coverage Ratio: the ratio of (x) Line II.A. to (y) the sum of Line II.B. and Line
II.C.
	  	  .    :1.00
			
		  	 E.     Minimum permitted Consolidated Fixed Charge Coverage Ratio for the Measurement Period ending on the Statement
Date:
	  	  .    :1.00
			
		  	 F.      Compliance:
	  	Yes/No
			
	III.	  	Section 7.11 (b) – Consolidated Leverage Ratio for the Measurement Period ending on the Statement Date:	  	
			
		  	 A.     Consolidated Funded Indebtedness at Statement Date:
	  	$            
			
		  	 B.     Consolidated EBITDA for Measurement Period (Line I.C. above):
	  	$            
			
		  	 C.     If such Statement Date ends on or after December 31, 2006:
	  	
			
		  	 1.      Cash on the balance sheet as of the Statement Date not subject to Liens (excluding Liens under the
Permitted Collateral Documents and Liens permitted under Section 7.01(q)):
	  	$            
			
		  	 2.      Aggregate amount of reserves:
	  	$            
			
		  	 3.      Line III.C.1. minus Line III.C.2. minus $2,000,000 (if less than zero, write
zero):
	  	$            
			
		  	 D.     Consolidated Leverage Ratio:
	  	
			
		  	 [If such Statement Date ends prior to December 31, 2006: the ratio of (x) Line III.A. to (y) Line III.B:]
  
 [If such Statement Date ends on or after December 31, 2006: the ratio of (x) Line
III.A minus Line III.C.3. to (y) Line III.B:]
	  	  .    :1.00
			
		  	 E.     Maximum permitted Consolidated Leverage Ratio for the Measurement Period ending on the Statement
Date:
	  	  .    :1.00
			
		  	 F.      Compliance:
	  	Yes/No

  

 MSC - Compliance Certificate 

 EXHIBIT L 
 FORM OF PAY REPORT 
  

											
	 Age of Receivable
	  	Amount of
Receivable	  	No Payment –Blank	  	No Payment –
Problem	  	Partial Pay	  	Miscellaneous
	 Less Than 120 Days
	  		  		  		  		  	
	 120 Days or More
	  		  		  		  		  	
	 TOTAL
	  		  		  		  		  	

  

 MSC - Compliance Certificate

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00114-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00114-of-00352.parquet"}]]