Document:

Exhibit 10.2.3

 

Option No.________

 

INTERCEPT PHARMACEUTICALS, INC.

 

Stock Option Grant Notice for Employees
and Consultants

Stock Option Grant under the

2012 Equity Incentive Plan

 

	1.	Name and Address of Participant:	
	 	 	 
	 	 	 
	 	 	 
	2.	Date of Option Grant:	 
	 	 	
	3.	Type of Grant:	 
	 	 	 
	4.	Maximum Number of Shares for which this Option is exercisable:	
	 	 	 
	5.	Exercise (purchase) price per share:	
	 	 	 
	6.	Option Expiration Date:	
	 	 	 
	7.	Vesting Start Date:	 
	 	 	 
	8.	Vesting Schedule:  This Option shall become exercisable (and the Shares issued upon exercise shall be vested) as follows provided the Participant is an Employee, director or Consultant of the Company or of an Affiliate on the applicable vesting date:

 

	[On the first anniversary of the Vesting Start Date	 	up to ____________ Shares
	 	 	 
	On the second anniversary of the Vesting Start Date	 	an additional __________ Shares
	 	 	 
	On the third anniversary of the Vesting Start Date	 	an additional __________ Shares]
	 	 	 

See Section 3 for vesting
in the event of a Change of Control (as defined herein).

 

The foregoing rights
are cumulative and are subject to the other terms and conditions of this Agreement and the Plan.

 

    	 

    	 

    

 

The Company and the
Participant acknowledge receipt of this Stock Option Grant Notice and agree to the terms of the Stock Option Agreement attached
hereto and incorporated by reference herein, the Company’s 2012 Equity Incentive Plan and the terms of this Option
Grant as set forth above.

 

	 	INTERCEPT PHARMACEUTICALS, INC.
	 	 	 	 
	 	By:	 
	 	 	Name:	 
	 	 	Title:	 
	 	 	 	 
	 	 
	 	Participant

 

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INTERCEPT PHARMACEUTICALS, INC.

 

STOCK OPTION AGREEMENT - INCORPORATED
TERMS AND CONDITIONS

 

AGREEMENT made as of
the date of grant set forth in the Stock Option Grant Notice by and between Intercept Pharmaceuticals, Inc. (the “Company”),
a Delaware corporation, and the individual whose name appears on the Stock Option Grant Notice (the “Participant”).

 

WHEREAS, the Company
desires to grant to the Participant an Option to purchase shares of its common stock, $0.001 par value per share (the “Shares”),
under and for the purposes set forth in the Company’s 2012 Equity Incentive Plan (the “Plan”);

 

WHEREAS, the Company
and the Participant understand and agree that any terms used and not defined herein have the same meanings as in the Plan; and

 

WHEREAS, the Company
and the Participant each intend that the Option granted herein shall be of the type set forth in the Stock Option Grant Notice.

 

NOW, THEREFORE, in
consideration of the mutual covenants hereinafter set forth and for other good and valuable consideration, the parties hereto agree
as follows:

 

1.           GRANT OF OPTION.

 

The Company hereby
grants to the Participant the right and option to purchase all or any part of an aggregate of the number of Shares set forth in
the Stock Option Grant Notice, on the terms and conditions and subject to all the limitations set forth herein, under United States
securities and tax laws, and in the Plan, which is incorporated herein by reference. The Participant acknowledges receipt of a
copy of the Plan.

 

2.           EXERCISE PRICE.

 

The exercise price
of the Shares covered by the Option shall be the amount per Share set forth in the Stock Option Grant Notice, subject to adjustment,
as provided in the Plan, in the event of a stock split, reverse stock split or other events affecting the holders of Shares after
the date hereof (the “Exercise Price”). Payment shall be made in accordance with Paragraph 9 of the Plan.

 

3.           EXERCISABILITY OF OPTION.

 

Subject to the
terms and conditions set forth in this Agreement and the Plan, the Option granted hereby shall become vested and exercisable as
set forth in the Stock Option Grant Notice and is subject to the other terms and conditions of this Agreement and the Plan.

 

    	 

    	 

    

 

Notwithstanding the foregoing,
except to the extent specifically provided to the contrary in any employment agreement between the Participant and the Company
or an Affiliate, in the event of (i) a Change of Control (as defined below) and the Participant’s service with the Company,
the acquiring or succeeding corporation or any Affiliate of any of the foregoing is terminated by such entity for any reason other
than for Cause within 12 months of the Change of Control, then, upon such termination, all of the Shares subject to this Option
which are then unvested shall be deemed vested and exercisable as of such termination unless this Option has otherwise expired
or been terminated pursuant to its terms, or (ii) a Corporate Transaction (as defined in Section 24(b) of the Plan) that is a Change
of Control in which the acquiring entity does not assume the Option, then, immediately prior to the Change of Control, all of the
Shares subject to this Option shall be deemed vested and exercisable immediately prior to the Change of Control unless this Option
has otherwise expired or been terminated pursuant to its terms.

 

Change of Control means the occurrence of any
of the following events:

 

		(i)	Ownership. Any “Person” (as such term is used in Sections 13(d) and 14(d) of
the Securities Exchange Act of 1934, as amended) becomes the “Beneficial Owner” (as defined in Rule 13d-3 under said
Act), directly or indirectly, of securities of the Company representing 50% or more of the total voting power represented by the
Company’s then outstanding voting securities (excluding for this purpose any such voting securities held by the Company or
its Affiliates or any employee benefit plan of the Company) pursuant to a transaction or a series of related transactions which
the Board of Directors does not approve; or

 

		(ii)	Merger/Sale of Assets. (A) A merger or consolidation of the Company whether or not approved
by the Board of Directors, other than a merger or consolidation which would result in the voting securities of the Company outstanding
immediately prior thereto continuing to represent (either by remaining outstanding or by being converted into voting securities
of the surviving entity or the parent of such corporation) more than 50% of the total voting power represented by the voting securities
of the Company or such surviving entity or parent of such corporation, as the case may be, outstanding immediately after such merger
or consolidation; or (B) the sale or disposition by the Company of all or substantially all of the Company’s assets in a
transaction requiring stockholder approval; or

 

		(iii)	Change in Board Composition. A change in the composition of the Board of Directors, as a
result of which fewer than a majority of the directors are Incumbent Directors. “Incumbent Directors” shall mean directors
who either (A) are directors of the Company as of the date of the grant, or (B) are elected, or nominated for election, to the
Board of Directors with the affirmative votes of at least a majority of the Incumbent Directors at the time of such election or
nomination (but shall not include an individual whose election or nomination is in connection with an actual or threatened proxy
contest relating to the election of directors to the Company).
	 	 	 

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		4.	TERM OF OPTION.

 

This Option shall terminate
on the Option Expiration Date as specified in the Stock Option Grant Notice and, if this Option is designated in the Stock Option
Grant Notice as an ISO and the Participant owns as of the date hereof more than 10% of the total combined voting power of all classes
of capital stock of the Company or an Affiliate, such date may not be more than five years from the date of this Agreement, but
shall be subject to earlier termination as provided herein or in the Plan.

 

If the Participant ceases
to be an Employee, director or Consultant of the Company or of an Affiliate for any reason other than the death or Disability of
the Participant, or termination of the Participant for Cause (the “Termination Date”), the Option to the extent then
vested and exercisable pursuant to Section 3 hereof as of the Termination Date, and not previously terminated in accordance with
this Agreement, may be exercised within three months after the Termination Date, or on or prior to the Option Expiration Date as
specified in the Stock Option Grant Notice, whichever is earlier, but may not be exercised thereafter except as set forth below.
In such event, the unvested portion of the Option shall not be exercisable and shall expire and be cancelled on the Termination
Date.

 

If this Option is designated
in the Stock Option Grant Notice as an ISO and the Participant ceases to be an Employee of the Company or of an Affiliate but continues
after termination of employment to provide service to the Company or an Affiliate as a director or Consultant, this Option shall
continue to vest in accordance with Section 3 above as if this Option had not terminated until the Participant is no longer providing
services to the Company. In such case, this Option shall automatically convert and be deemed a Non-Qualified Option as of the date
that is three months from termination of the Participant's employment and this Option shall continue on the same terms and conditions
set forth herein until such Participant is no longer providing service to the Company or an Affiliate.

 

Notwithstanding the foregoing,
in the event of the Participant’s Disability or death within three months after the Termination Date, the Participant or
the Participant’s Survivors may exercise the Option within one year after the Termination Date, but in no event after the
Option Expiration Date as specified in the Stock Option Grant Notice.

 

In the event the Participant’s
service is terminated by the Company or an Affiliate for Cause, the Participant’s right to exercise any unexercised portion
of this Option even if vested shall cease immediately as of the time the Participant is notified his or her service is terminated
for Cause, and this Option shall thereupon terminate. Notwithstanding anything herein to the contrary, if subsequent to the Participant’s
termination, but prior to the exercise of the Option, the Administrator determines that, either prior or subsequent to the Participant’s
termination, the Participant engaged in conduct which would constitute Cause, then the Participant shall immediately cease to have
any right to exercise the Option and this Option shall thereupon terminate.

 

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In the event of the Disability
of the Participant, as determined in accordance with the Plan, the Option shall be exercisable within one year after the Participant’s
termination of service due to Disability or, if earlier, on or prior to the Option Expiration Date as specified in the Stock Option
Grant Notice. In such event, the Option shall be exercisable:

 

		(a)	to the extent that the Option has become exercisable but has not been exercised as of the date
of the Participant’s termination of service due to Disability; and

 

		(b)	in the event rights to exercise the Option accrue periodically, to the extent of a pro rata portion
through the date of the Participant’s termination of service due to Disability of any additional vesting rights that would
have accrued on the next vesting date had the Participant not become Disabled. The proration shall be based upon the number of
days accrued in the current vesting period prior to the date of the Participant’s termination of service due to Disability.

 

In the event of the death
of the Participant while an Employee, director or Consultant of the Company or of an Affiliate, the Option shall be exercisable
by the Participant’s Survivors within one year after the date of death of the Participant or, if earlier, on or prior to
the Option Expiration Date as specified in the Stock Option Grant Notice. In such event, the Option shall be exercisable:

 

		(x)	to the extent that the Option has become exercisable but has not been exercised as of the date
of death; and

 

		(y)	in the event rights to exercise the Option accrue periodically, to the extent of a pro rata portion
through the date of death of any additional vesting rights that would have accrued on the next vesting date had the Participant
not died. The proration shall be based upon the number of days accrued in the current vesting period prior to the Participant’s
date of death.

 

		5.	METHOD OF EXERCISING OPTION.

 

Subject to the terms
and conditions of this Agreement, the Option may be exercised by written notice to the Company or its designee, in substantially
the form of Exhibit A attached hereto (or in such other form acceptable to the Company, which may include electronic
notice). Such notice shall state the number of Shares with respect to which the Option is being exercised and shall be signed by
the person exercising the Option (which signature may be provided electronically in a form acceptable to the Company). Payment
of the Exercise Price for such Shares shall be made in accordance with Paragraph 9 of the Plan. The Company shall deliver such
Shares as soon as practicable after the notice shall be received, provided, however, that the Company may delay issuance of such
Shares until completion of any action or obtaining of any consent, which the Company deems necessary under any applicable law (including,
without limitation, state securities or “blue sky” laws). The Shares as to which the Option shall have been so exercised
shall be registered in the Company’s share register in the name of the person so exercising the Option (or, if the Option
shall be exercised by the Participant and if the Participant shall so request in the notice exercising the Option, shall be registered
in the Company’s share register in the name of the Participant and another person jointly, with right of survivorship) and
shall be delivered as provided above to or upon the written order of the person exercising the Option. In the event the Option
shall be exercised, pursuant to Section 4 hereof, by any person other than the Participant, such notice shall be accompanied by
appropriate proof of the right of such person to exercise the Option. All Shares that shall be purchased upon the exercise of the
Option as provided herein shall be fully paid and nonassessable.

 

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		6.	PARTIAL EXERCISE.

 

Exercise of this Option
to the extent above stated may be made in part at any time and from time to time within the above limits, except that no fractional
share shall be issued pursuant to this Option.

 

		7.	NON-ASSIGNABILITY.

 

The Option shall not
be transferable by the Participant otherwise than by will or by the laws of descent and distribution. If this Option is a Non-Qualified
Option then it may also be transferred pursuant to a qualified domestic relations order as defined by the Code or Title I of the
Employee Retirement Income Security Act or the rules thereunder.  Except as provided above in this paragraph, the Option
shall be exercisable, during the Participant’s lifetime, only by the Participant (or, in the event of legal incapacity or
incompetency, by the Participant’s guardian or representative) and shall not be assigned, pledged or hypothecated in any
way (whether by operation of law or otherwise) and shall not be subject to execution, attachment or similar process. Any attempted
transfer, assignment, pledge, hypothecation or other disposition of the Option or of any rights granted hereunder contrary to the
provisions of this Section 7, or the levy of any attachment or similar process upon the Option shall be null and void.

 

		8.	NO RIGHTS AS STOCKHOLDER UNTIL EXERCISE.

 

The Participant shall
have no rights as a stockholder with respect to Shares subject to this Agreement until registration of the Shares in the Company’s
share register in the name of the Participant. Except as is expressly provided in the Plan with respect to certain changes in the
capitalization of the Company, no adjustment shall be made for dividends or similar rights for which the record date is prior to
the date of such registration.

 

		9.	ADJUSTMENTS.

 

The Plan contains provisions
covering the treatment of Options in a number of contingencies such as stock splits and mergers. Provisions in the Plan for adjustment
with respect to stock subject to Options and the related provisions with respect to successors to the business of the Company are
hereby made applicable hereunder and are incorporated herein by reference.

 

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		10.	TAXES.

 

The Participant acknowledges
that any income or other taxes due from him or her with respect to this Option or the Shares issuable pursuant to this Option shall
be the Participant’s responsibility. The Participant acknowledges and agrees that (i) the Participant was free to use professional
advisors of his or her choice in connection with this Agreement, has received advice from his or her professional advisors in connection
with this Agreement, understands its meaning and import, and is entering into this Agreement freely and without coercion or duress;
(ii) the Participant has not received and is not relying upon any advice, representations or assurances made by or on behalf of
the Company or any Affiliate or any employee of or counsel to the Company or any Affiliate regarding any tax or other effects or
implications of the Option, the Shares or other matters contemplated by this Agreement; and (iii) neither the Administrator, the
Company, its Affiliates, nor any of its officers or directors, shall be held liable for any applicable costs, taxes, or penalties
associated with the Option if, in fact, the Internal Revenue Service were to determine that the Option constitutes deferred compensation
under Section 409A of the Code.

 

If this Option is designated
in the Stock Option Grant Notice as a Non-Qualified Option or if the Option is an ISO and is converted into a Non-Qualified Option
and such Non-Qualified Option is exercised, the Participant agrees that the Company may withhold from the Participant’s remuneration,
if any, the minimum statutory amount of federal, state and local withholding taxes attributable to such amount that is considered
compensation includable in such person’s gross income. At the Company’s discretion, the amount required to be withheld
may be withheld in cash from such remuneration, or in kind from the Shares otherwise deliverable to the Participant on exercise
of the Option. The Participant further agrees that, if the Company does not withhold an amount from the Participant’s remuneration
sufficient to satisfy the Company’s income tax withholding obligation, the Participant will reimburse the Company on demand,
in cash, for the amount under-withheld.

 

		11.	PURCHASE FOR INVESTMENT.

 

Unless the offering and
sale of the Shares to be issued upon the particular exercise of the Option shall have been effectively registered under the Securities
Act, the Company shall be under no obligation to issue the Shares covered by such exercise unless the Company has determined that
such exercise and issuance would be exempt from the registration requirements of the Securities Act and until the following conditions
have been fulfilled:

 

		(a)	The person(s) who exercise the Option shall warrant to the Company, at the time of such exercise,
that such person(s) are acquiring such Shares for their own respective accounts, for investment, and not with a view to, or for
sale in connection with, the distribution of any such Shares, in which event the person(s) acquiring such Shares shall be bound
by the provisions of the following legend which shall be endorsed upon any certificate(s) evidencing the Shares issued pursuant
to such exercise:

 

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“The shares represented
by this certificate have been taken for investment and they may not be sold or otherwise transferred by any person, including a
pledgee, unless (1) either (a) a Registration Statement with respect to such shares shall be effective under the Securities Act
of 1933, as amended, or (b) the Company shall have received an opinion of counsel satisfactory to it that an exemption from registration
under such Act is then available, and (2) there shall have been compliance with all applicable state securities laws;” and

 

	 	(b) 	If the Company so requires,
the Company shall have received an opinion of its counsel that the Shares may be issued upon such particular exercise in compliance
with the Securities Act without registration thereunder. Without limiting the generality of the foregoing, the Company may delay
issuance of the Shares until completion of any action or obtaining of any consent, which the Company deems necessary under any
applicable law (including without limitation state securities or “blue sky” laws). 

  

		12.	RESTRICTIONS ON TRANSFER OF SHARES.

 

12.1        The Participant
agrees that in the event the Company proposes to offer for sale to the public any of its equity securities and such Participant
is requested by the Company and any underwriter engaged by the Company in connection with such offering to sign an agreement restricting
the sale or other transfer of Shares, then it will promptly sign such agreement and will not transfer, whether in privately negotiated
transactions or to the public in open market transactions or otherwise, any Shares or other securities of the Company held by him
or her during such period as is determined by the Company and the underwriters, not to exceed 180 days following the closing of
the offering, plus such additional period of time as may be required to comply with the rules of the Financial Industry Regulatory
Authority, Inc. or similar rules thereto (such period, the “Lock-Up Period”). Such agreement shall be in writing and
in form and substance reasonably satisfactory to the Company and such underwriter and pursuant to customary and prevailing terms
and conditions. Notwithstanding whether the Participant has signed such an agreement, the Company may impose stop-transfer instructions
with respect to the Shares or other securities of the Company subject to the foregoing restrictions until the end of the Lock-Up
Period.

 

12.2        The Participant
acknowledges and agrees that neither the Company, its shareholders nor its directors and officers, has any duty or obligation to
disclose to the Participant any material information regarding the business of the Company or affecting the value of the Shares
before, at the time of, or following a termination of the service of the Participant by the Company, including, without limitation,
any information concerning plans for the Company to make a public offering of its securities or to be acquired by or merged with
or into another firm or entity.

 

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		13.	NO OBLIGATION TO MAINTAIN RELATIONSHIP.

 

The Participant acknowledges
that: (i) the Company is not by the Plan or this Option obligated to continue the Participant as an Employee, director or Consultant
of the Company or an Affiliate; (ii) the Plan is discretionary in nature and may be suspended or terminated by the Company at any
time; (iii) the grant of the Option is a one-time benefit which does not create any contractual or other right to receive future
grants of options, or benefits in lieu of options; (iv) all determinations with respect to any such future grants, including, but
not limited to, the times when options shall be granted, the number of shares subject to each option, the option price, and the
time or times when each option shall be exercisable, will be at the sole discretion of the Company; (v) the Participant’s
participation in the Plan is voluntary; (vi) the value of the Option is an extraordinary item of compensation which is outside
the scope of the Participant’s employment or consulting contract, if any; and (vii) the Option is not part of normal or expected
compensation for purposes of calculating any severance, resignation, redundancy, end of service payments, bonuses, long-service
awards, pension or retirement benefits or similar payments.

 

		14.	IF OPTION IS INTENDED TO BE AN ISO.

 

If this Option is designated
in the Stock Option Grant Notice as an ISO so that the Participant (or the Participant’s Survivors) may qualify for the favorable
tax treatment provided to holders of Options that meet the standards of Section 422 of the Code then any provision of this Agreement
or the Plan which conflicts with the Code so that this Option would not be deemed an ISO is null and void and any ambiguities shall
be resolved so that the Option qualifies as an ISO. The Participant should consult with the Participant’s own tax advisors
regarding the tax effects of the Option and the requirements necessary to obtain favorable tax treatment under Section 422 of the
Code, including, but not limited to, holding period requirements.

 

Notwithstanding the foregoing,
to the extent that the Option is designated in the Stock Option Grant Notice as an ISO and is not deemed to be an ISO pursuant
to Section 422(d) of the Code because the aggregate Fair Market Value (determined as of the Date of Option Grant) of any of the
Shares with respect to which this ISO is granted becomes exercisable for the first time during any calendar year in excess of $100,000,
the portion of the Option representing such excess value shall be treated as a Non-Qualified Option and the Participant shall be
deemed to have taxable income measured by the difference between the then Fair Market Value of the Shares received upon exercise
and the price paid for such Shares pursuant to this Agreement.

 

Neither the Company nor
any Affiliate shall have any liability to the Participant, or any other party, if the Option (or any part thereof) that is intended
to be an ISO is not an ISO or for any action taken by the Administrator, including without limitation the conversion of an ISO
to a Non-Qualified Option.

 

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		15.	NOTICE TO COMPANY OF DISQUALIFYING DISPOSITION OF AN ISO.

 

If this Option is designated
in the Stock Option Grant Notice as an ISO then the Participant agrees to notify the Company in writing immediately after the Participant
makes a Disqualifying Disposition of any of the Shares acquired pursuant to the exercise of the ISO. A Disqualifying Disposition
is defined in Section 424(c) of the Code and includes any disposition (including any sale) of such Shares before the later of (a)
two years after the date the Participant was granted the ISO or (b) one year after the date the Participant acquired Shares by
exercising the ISO, except as otherwise provided in Section 424(c) of the Code. If the Participant has died before the Shares are
sold, these holding period requirements do not apply and no Disqualifying Disposition can occur thereafter.

 

		16.	NOTICES.

 

Any notices required
or permitted by the terms of this Agreement or the Plan shall be given by recognized courier service, facsimile, registered or
certified mail, return receipt requested, addressed as follows:

 

If to the Company:

 

Intercept Pharmaceuticals, Inc.

18 Desbrosses Street

New York, NY 10013

Attention: Chief Financial Officer

 

If to the Participant at the address set forth on the Stock
Option Grant Notice

 

or to such other address or addresses of which notice in the
same manner has previously been given. Any such notice shall be deemed to have been given upon the earlier of receipt, one business
day following delivery to a recognized courier service or three business days following mailing by registered or certified mail.

 

		17.	GOVERNING LAW.

 

This Agreement shall
be governed by and construed in accordance with the laws of the State of Delaware, without giving effect to the conflict of law
principles thereof. For the purpose of litigating any dispute that arises under this Agreement, the parties hereby consent to exclusive
jurisdiction in New York and agree that such litigation shall be conducted in the state courts of New York County, New York
or the federal courts of the United States for the District of the Southern District of New York.

 

		18.	BENEFIT OF AGREEMENT.

 

Subject to the provisions
of the Plan and the other provisions hereof, this Agreement shall be for the benefit of and shall be binding upon the heirs, executors,
administrators, successors and assigns of the parties hereto.

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		19.	ENTIRE AGREEMENT.

 

This Agreement, together
with the Plan, embodies the entire agreement and understanding between the parties hereto with respect to the subject matter hereof
and supersedes all prior oral or written agreements and understandings relating to the subject matter hereof. No statement, representation,
warranty, covenant or agreement not expressly set forth in this Agreement shall affect or be used to interpret, change or restrict,
the express terms and provisions of this Agreement, provided, however, in any event, this Agreement shall be subject to and governed
by the Plan.

 

		20.	MODIFICATIONS AND AMENDMENTS.

 

The terms and provisions
of this Agreement may be modified or amended as provided in the Plan.

 

		21.	WAIVERS AND CONSENTS.

 

Except as provided in
the Plan, the terms and provisions of this Agreement may be waived, or consent for the departure therefrom granted, only by written
document executed by the party entitled to the benefits of such terms or provisions. No such waiver or consent shall be deemed
to be or shall constitute a waiver or consent with respect to any other terms or provisions of this Agreement, whether or not similar.
Each such waiver or consent shall be effective only in the specific instance and for the purpose for which it was given, and shall
not constitute a continuing waiver or consent.

 

		22.	DATA PRIVACY.

 

By entering into this
Agreement, the Participant: (i) authorizes the Company and each Affiliate, and any agent of the Company or any Affiliate administering
the Plan or providing Plan recordkeeping services, to disclose to the Company or any of its Affiliates such information and data
as the Company or any such Affiliate shall request in order to facilitate the grant of options and the administration of the Plan;
and (ii) authorizes the Company and each Affiliate to store and transmit such information in electronic form for the purposes set
forth in this Agreement.

 

[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

 

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Exhibit A

 

 

NOTICE OF EXERCISE OF STOCK OPTION

 

[Form for Shares registered in
the United States]

 

		To:	Intercept Pharmaceuticals, Inc.

 

IMPORTANT NOTICE: This form of Notice of Exercise may only be
used at such time as the Company has filed a Registration Statement with the Securities and Exchange Commission under which the
issuance of the Shares for which this exercise is being made is registered and such Registration Statement remains effective.

 

Ladies and Gentlemen:

 

I hereby exercise my
Stock Option to purchase _________ shares (the “Shares”) of the common stock, $0.001 par value, of Intercept Pharmaceuticals,
Inc. (the “Company”), at the exercise price of $________ per share, pursuant to and subject to the terms of
that Stock Option Grant Notice dated _______________, 201_.

 

I understand the nature
of the investment I am making and the financial risks thereof. I am aware that it is my responsibility to have consulted with competent
tax and legal advisors about the relevant national, state and local income tax and securities laws affecting the exercise of the
Option and the purchase and subsequent sale of the Shares.

 

I am paying the option
exercise price for the Shares as follows:

 

 

 

 

Please issue the Shares (check one):

 

 ̈ to
me; or

 

 ̈
to me and ____________________________, as joint tenants with right of survivorship,

 

at the following address:

 

	 	 	 
	 	 	 
	 	 	 

 

    	Exhibit A-1

    	 

    

 

My mailing address
for shareholder communications, if different from the address listed above, is:

 

	 	 	 
	 	 	 
	 	 	 

 

	 	Very truly yours,
	 	 
	 	 
	 	 	Participant (signature)
	 	 
	 	 
	 	 	Print Name
	 	 
	 	 
	 	 	Date

 

    	Exhibit A-2Exhibit 10.2.4

 

Restricted Stock Unit No.________

 

INTERCEPT PHARMACEUTICALS, INC.

 

Restricted Stock Unit Award Grant Notice
for Directors

Restricted Stock Unit Award Grant under
the Company’s

2012 Equity
Incentive Plan

 

	1.	Name and Address of Participant:	 
	 	 	 
	 	 	 
	 	 	 
	2.	Date of Grant of Restricted Stock Unit Award:	 
	 	 	 
	3.	Maximum Number of Shares underlying Restricted Stock Unit Award:	 
	 	 
	4.	Vesting of Award:  This Restricted Stock Unit Award shall vest as follows provided the Participant is an Employee, director or Consultant of the Company or of an Affiliate on the applicable vesting date:

 

	Number of Restricted Stock Units	 	Vesting Date
	[__]% of the Maximum Number of Shares	 	_________, 20__
	[__]% of the Maximum Number of Shares	 	[_________]

 

See Section 2(d) for
vesting in the event of a Change of Control (as defined herein).

 

The Company and the
Participant acknowledge receipt of this Restricted Stock Unit Award Grant Notice and agree to the terms of the Restricted Stock
Unit Agreement attached hereto and incorporated by reference herein, the Company’s 2012 Equity
Incentive Plan and the terms of this Restricted Stock Unit Award as set forth above.

 

	 	INTERCEPT PHARMACEUTICALS, INC.
	 	 
	 	By:	 
	 	Name:	 
	 	Title:	 
	 	 
	 	 
	 	Participant

 

    	 

    	 

    

  

INTERCEPT PHARMACEUTICALS, INC.

 

RESTRICTED STOCK UNIT AGREEMENT -

INCORPORATED TERMS AND CONDITIONS

 

AGREEMENT made as of
the date of grant set forth in the Restricted Stock Unit Award Grant Notice between Intercept Pharmaceuticals, Inc. (the “Company”),
a Delaware corporation, and the individual whose name appears on the Restricted Stock Unit Award Grant Notice (the “Participant”).

 

WHEREAS, the Company has adopted the Intercept
Pharmaceuticals, Inc. 2012 Equity Incentive Plan (the “Plan”), to promote the interests
of the Company by providing an incentive for directors of the Company and its Affiliates;

 

WHEREAS, pursuant to
the provisions of the Plan, the Company desires to grant to the Participant restricted stock units (“RSUs”) related
to the Company’s common stock, par value $0.001 per share (“Common Stock”), in accordance with the provisions
of the Plan, all on the terms and conditions hereinafter set forth; and

 

WHEREAS, the Company
and the Participant understand and agree that any terms used and not defined herein have the meanings ascribed to such terms in
the Plan.

 

NOW, THEREFORE, in
consideration of the premises and the mutual covenants contained herein and for other good and valuable consideration, the receipt
and sufficiency of which are hereby acknowledged, the parties hereto hereby agree as follows:

 

1.          Grant
of Award. The Company hereby grants to the Participant the number of RSUs set forth in the Restricted Stock Unit Award Grant
Notice (the “Award”) which represents a contingent entitlement of the Participant to receive shares of Common Stock,
on the terms and conditions and subject to all the limitations set forth herein and in the Plan, which is incorporated herein by
reference. The Participant acknowledges receipt of a copy of the Plan.

 

2.          Vesting
of Award.

 

(a)        Subject
to the terms and conditions set forth in this Agreement and the Plan, the Award granted hereby shall vest as set forth in the Restricted
Stock Unit Award Grant Notice and is subject to the other terms and conditions of this Agreement and the Plan. On each vesting
date set forth in the Restricted Stock Unit Award Grant Notice, the Participant shall be entitled to receive such number of shares
of Common Stock equivalent to the number of RSUs set forth opposite such vesting date provided that, on such vesting date, the
Participant is a director, Employee or Consultant of the Company or an Affiliate. Such shares of Common Stock shall thereafter
be delivered by the Company to the Participant within five days of the applicable vesting date and in accordance with this Agreement
and the Plan. The purchase price is $0.001 per share payable if and when shares of Common Stock are issued by the Company,
which payment will be made by the Company on behalf of the Participant as compensation for the Participant’s prior service
to the Company and which amount will be reported as income on the Participant’s W-2 (or other applicable form) in the year
of payment.

 

(b)        Except
as otherwise set forth in this Agreement, if the Participant ceases to be, for any reason, a director, Employee or Consultant of
the Company or an Affiliate (the “Termination”) prior to a vesting date set forth in the Restricted Stock Unit Award
Grant Notice, then as of the date on which such relationship is terminated with the Participant, all unvested RSUs shall immediately
be forfeited to the Company and this Agreement shall terminate and be of no further force or effect.

 

(c)        Effect
of a For Cause Termination. Notwithstanding anything to the contrary contained in this Agreement, in the event the Company
or an Affiliate terminates the Participant’s employment or service, as the case may be, for Cause, all of the RSUs then held
by the Participant shall be forfeited to the Company immediately as of the time the Participant is notified that his or her employment
or service has been terminated for Cause or that he or she engaged in conduct which would constitute Cause and this Agreement shall
terminate and be of no further force or effect.

 

    	 

    	 

    

 

(d)        Change
of Control. Notwithstanding the foregoing, in the event of a Change of Control (as defined below), then, immediately prior
to the Change of Control, all of the RSUs subject to this Award that are then unvested shall be deemed vested as of immediately
prior to such Change of Control and the Participant shall receive immediately prior to such Change of Control such number of shares
of Common Stock equivalent to the number of RSUs subject to this Award which have not yet vested under this Agreement.

 

Change of Control means the occurrence
of any of the following events:

 

		(i)	Ownership. Any “Person” (as such term is used in Sections 13(d) and 14(d) of
the Securities Exchange Act of 1934, as amended) becomes the “Beneficial Owner” (as defined in Rule 13d-3 under said
Act), directly or indirectly, of securities of the Company representing 50% or more of the total voting power represented by the
Company’s then outstanding voting securities (excluding for this purpose any such voting securities held by the Company or
its Affiliates or any employee benefit plan of the Company) pursuant to a transaction or a series of related transactions which
the Board of Directors does not approve; or

 

		(ii)	Merger/Sale of Assets. (A) A merger or consolidation of the Company whether or not approved
by the Board of Directors, other than a merger or consolidation which would result in the voting securities of the Company outstanding
immediately prior thereto continuing to represent (either by remaining outstanding or by being converted into voting securities
of the surviving entity or the parent of such corporation) more than 50% of the total voting power represented by the voting securities
of the Company or such surviving entity or parent of such corporation, as the case may be, outstanding immediately after such merger
or consolidation; or (B) the sale or disposition by the Company of all or substantially all of the Company’s assets in a
transaction requiring stockholder approval; or

 

		(iii)	Change in Board Composition. A change in the composition of the Board of Directors, as a
result of which fewer than a majority of the directors are Incumbent Directors. “Incumbent Directors” shall mean directors
who either (A) are directors of the Company as of the date of grant of this award, or (B) are elected, or nominated for election,
to the Board of Directors with the affirmative votes of at least a majority of the Incumbent Directors at the time of such election
or nomination (but shall not include an individual whose election or nomination is in connection with an actual or threatened proxy
contest relating to the election of directors to the Company).

 

		(iv)	“Change of Control” shall be interpreted, if applicable, in a manner, and limited to
the extent necessary, so that it will not cause adverse tax consequences under Section 409A.

 

3.          Prohibitions
on Transfer and Sale. This Award (including any additional RSUs received by the Participant as a result of stock dividends,
stock splits or any other similar transaction affecting the Company's securities without receipt of consideration) shall not be
transferable by the Participant otherwise than (i) by will or by the laws of descent and distribution, or (ii) pursuant to a qualified
domestic relations order as defined by the Internal Revenue Code or Title I of the Employee Retirement Income Security Act or the
rules thereunder. Except as provided in the previous sentence, the shares of Common Stock to be issued pursuant to this Agreement
shall be issued, during the Participant's lifetime, only to the Participant (or, in the event of legal incapacity or incompetence,
to the Participant's guardian or representative). This Award shall not be assigned, pledged or hypothecated in any way (whether
by operation of law or otherwise) and shall not be subject to execution, attachment or similar process. Any attempted transfer,
assignment, pledge, hypothecation or other disposition of this Award or of any rights granted hereunder contrary to the provisions
of this Section 3, or the levy of any attachment or similar process upon this Award shall be null and void.

 

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4.          Adjustments.
The Plan contains provisions covering the treatment of RSUs and shares of Common Stock in a number of contingencies such as stock
splits. Provisions in the Plan for adjustment with respect to this Award and the related provisions with respect to successors
to the business of the Company are hereby made applicable hereunder and are incorporated herein by reference.

 

5.          Securities
Law Compliance. The Participant specifically acknowledges and agrees that any sales of shares of Common Stock shall be made
in accordance with the requirements of the Securities Act of 1933, as amended. The Company
currently has an effective registration statement on file with the Securities and Exchange Commission with respect to the Common
Stock to be granted hereunder. The Company intends to maintain this registration statement but has no obligation to do so. If the
registration statement ceases to be effective for any reason or there is a restriction under foreign law, a Participant will not
be able to transfer or sell any of the shares of Common Stock issued to the Participant pursuant to this Agreement unless exemptions
from registration or filings under applicable securities laws are available. Furthermore, despite registration, applicable securities
laws may restrict the ability of the Participant to resell his or her Common Stock, including due to the Participant’s affiliation
with the Company. The Company shall not be obligated to either issue the Common Stock or permit the resale of any shares of Common
Stock if such issuance or resale would violate any applicable securities law, rule or regulation.

 

6.          Rights
as a Stockholder. The Participant shall have no right as a stockholder, including voting and dividend rights, with respect
to the RSUs subject to this Agreement.

 

7.          Incorporation
of the Plan. The Participant specifically understands and agrees that the RSUs and the shares of Common Stock to be issued
under the Plan will be issued to the Participant pursuant to the Plan, a copy of which Plan the Participant acknowledges he or
she has read and understands and by which Plan he or she agrees to be bound. The provisions of the Plan are incorporated herein
by reference.

 

8.          Tax
Liability of the Participant and Payment of Taxes. The Participant acknowledges and agrees that any income or other
taxes due from the Participant with respect to this Award or the shares of Common Stock to be issued pursuant to this Agreement
or otherwise sold shall be the Participant’s responsibility. Without limiting the foregoing, the Participant agrees that
if under applicable law the Participant will owe taxes at each vesting date on the portion of the Award then vested the Company
shall be entitled to immediate payment from the Participant of the amount of any tax required to be withheld by the Company. Any
taxes due shall be paid, at the option of the Company as follows:

 

(a)          through
reducing the number of shares of Common Stock entitled to be issued to the Participant on the applicable vesting date in an amount
equal to the amount of minimum withholding tax due and payable by the Company. Fractional shares will not be retained to satisfy
any portion of the withholding tax. Accordingly, the Participant agrees that in the event that the amount of withholding tax owed
would result in a fraction of a share being owed, that amount will be satisfied by withholding the fractional amount from the Participant’s
paycheck;

 

(b)          requiring
the Participant to deposit with the Company an amount of cash equal to the amount determined by the Company to be required with
respect to the statutory minimum of the Participant’s estimated total federal, state and local tax obligations or otherwise
withholding from the Participant’s paycheck an amount equal to the withholding tax due and payable; or

 

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(c)          if
the Company believes that the sale of shares can be made in compliance with applicable securities laws, authorizing, at a time
when the Participant is not in possession of material nonpublic information, the sale by the Participant on the applicable vesting
date of such number of shares of Common Stock as the Company instructs a registered broker to sell to satisfy the Company’s
withholding obligation, after deduction of the broker’s commission, and the broker shall be required to remit to the Company
the cash necessary in order for the Company to satisfy its withholding obligation. To the extent the proceeds of such sale exceed
the Company’s tax withholding obligation the Company agrees to pay such excess cash to the Participant as soon as practicable.
In addition, if such sale is not sufficient to pay the Company’s tax withholding obligation the Participant agrees to pay
to the Company as soon as practicable, including through additional payroll withholding, the amount of any tax withholding obligation
that is not satisfied by the sale of shares of Common Stock. The Participant agrees to hold the Company and the broker harmless
from all costs, damages or expenses relating to any such sale. The Participant acknowledges that the Company and the broker are
under no obligation to arrange for such sale at any particular price. In connection with such sale of shares of Common Stock, the
Participant shall execute any such documents requested by the broker in order to effectuate the sale of shares of Common Stock
and payment of the withholding obligation to the Company. The Participant acknowledges that this paragraph is intended to comply
with Section 10b5-1(c)(1(i)(B) under the Exchange Act.

 

The Company shall not
deliver any shares of Common Stock to the Participant until it is satisfied that all required withholdings have been made.

 

		9.	Participant Acknowledgements and Authorizations.

 

The Participant
acknowledges the following:

 

(a)          The
Company is not by the Plan or this Award obligated to continue the Participant as an Employee, director or Consultant of the Company
or of an Affiliate.

 

(b)          The
Plan is discretionary in nature and may be suspended or terminated by the Company at any time.

 

(c)          The
grant of this Award is considered a one-time benefit and does not create a contractual or other right to receive any other award
under the Plan, benefits in lieu of awards or any other benefits in the future.

 

(d)         The Plan
is a voluntary program of the Company and future awards, if any, will be at the sole discretion of the Company, including, but
not limited to, the timing of any grant, the amount of any award, vesting provisions and the purchase price, if any.

 

(e)          The
value of this Award is an extraordinary item of compensation outside of the scope of any employment or service. As such, the Award
is not part of normal or expected compensation for purposes of calculating any severance, resignation, redundancy, end of service
payments, bonuses, long-service awards, pension or retirement benefits or similar payments. The future value of the shares of Common
Stock is unknown and cannot be predicted with certainty.

 

(f)          The
Participant (i) authorizes the Company and its Affiliates or, if the Participant is not employed by the Company or an Affiliate,
his or her employer, to furnish the Company and its Affiliates (and any agent administering the Plan or providing recordkeeping
services) with such information and data as it shall request in order to facilitate the grant of the Award and the administration
of the Plan, (ii) waives any data privacy rights he or she may have with respect to such information or the sharing of such information,
and (iii) authorizes the Company and its Affiliates to store and transmit such information in electronic form.

 

10.         Notices.
Any notices required or permitted by the terms of this Agreement or the Plan shall be given by recognized courier service, facsimile,
registered or certified mail, return receipt requested, addressed as follows:

 

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If to the Company:

 

Intercept Pharmaceuticals, Inc.

18 Desbrosses Street

New York, NY 10013

Attention: Chief Financial Officer

 

If to the Participant at the address set
forth on the Restricted Stock Unit Award Grant Notice

 

or to such other address or addresses of
which notice in the same manner has previously been given. Any such notice shall be deemed to have been given on the earliest of
receipt, one business day following delivery by the sender to a recognized courier service, or three business days following mailing
by registered or certified mail.

 

		11.	Assignment and Successors.

 

(a)          This
Agreement is personal to the Participant and without the prior written consent of the Company shall not be assignable by the Participant
otherwise than by will or the laws of descent and distribution. This Agreement shall inure to the benefit of and be enforceable
by the Participant’s legal representatives.

 

(b)          This
Agreement shall inure to the benefit of and be binding upon the Company and its successors and assigns.

 

12.         Governing
Law. This Agreement shall be construed and enforced in accordance with the laws of the Delaware, without giving effect to the
conflict of law principles thereof. For the purpose of litigating any dispute that arises under this Agreement, whether at law
or in equity, the parties hereby consent to exclusive jurisdiction in the state of New York and agree that such litigation shall
be conducted in the state courts of New York or the federal courts of the United States for the Southern District of New York.

 

13.         Severability.
If any provision of this Agreement is held to be invalid or unenforceable by a court of competent jurisdiction, then such provision
or provisions shall be modified to the extent necessary to make such provision valid and enforceable, and to the extent that this
is impossible, then such provision shall be deemed to be excised from this Agreement, and the validity, legality and enforceability
of the rest of this Agreement shall not be affected thereby.

 

14.         Entire
Agreement. This Agreement, together with the Plan, constitutes the entire agreement and understanding between the parties hereto
with respect to the subject matter hereof and supersedes all prior oral or written agreements and understandings relating to the
subject matter hereof. No statement, representation, warranty, covenant or agreement not expressly set forth in this Agreement
shall affect or be used to interpret, change or restrict the express terms and provisions of this Agreement provided, however,
in any event, this Agreement shall be subject to and governed by the Plan.

 

15.         Modifications
and Amendments; Waivers and Consents. The terms and provisions of this Agreement may be modified or amended as provided in
the Plan. Except as provided in the Plan, the terms and provisions of this Agreement may be waived, or consent for the departure
therefrom granted, only by written document executed by the party entitled to the benefits of such terms or provisions. No such
waiver or consent shall be deemed to be or shall constitute a waiver or consent with respect to any other terms or provisions of
this Agreement, whether or not similar. Each such waiver or consent shall be effective only in the specific instance and for the
purpose for which it was given, and shall not constitute a continuing waiver or consent.

 

16.         Section
409A. The Award of RSUs evidenced by this Agreement is intended to be exempt from the nonqualified deferred compensation rules
of Section 409A of the Code as a “short term deferral” (as that term is used in the final regulations and other guidance
issued under Section 409A of the Code, including Treasury Regulation Section 1.409A-1(b)(4)(i)), and shall be construed accordingly.

 

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