Document:

EX-4.30

 Exhibit 4.30 

DEED OF CONSENT AND AMENDMENT TO NOTE INSTRUMENT 

THIS DEED is dated 24 November 2020 (such date being the “Effective Date”) 

BETWEEN: 
  

	(1)	 MEREO BIOPHARMA GROUP PLC, a public limited company incorporated in England and Wales with company
number 04206001 whose registered office is at 4th Floor, One Cavendish Place, London, England W1G 0QF (the “Company”); and 

  

	(2)	 NOVARTIS PHARMA AG, a company incorporated and registered in Switzerland whose registetered office is at
Postfach, 4002 Basel Switzerland (“Novartis”). 

 WHEREAS 

 

	(A)	 The Company adopted a convertible loan note instrument on 10 February 2020 a copy of which is appended
hereto as Appendix 1 (the “Note Instrument”) constituting certain loan notes convertible into Ordinary Shares in the capital of the Company (the “Notes”). 

 

	(B)	 The Company is intending to cancel the admission to trading of its Ordinary Shares on the Alternative
Investment Market (“AIM”) operated by the London Stock Exchange, with effect from 18 December 2020 (the “Delisting”). Following the Delisting, the only listing maintained by the Company will be that of American
depositary receipts on NASDAQ, the tradeable entitlement representing American Depositary Shares (“ADSs”), each of which such ADS represents five Ordinary Shares of £0.003 in the capital of the Company. 

 

	(C)	 In parallel to implementing the Delisting, the Company has made the decision to refinance its existing senior
debt (provided by Silicon Valley Bank and Kreos Capital) with a new senior secured loan of up to USD 35,000,000 with a variable interest rate between 7.89% and 10% from Oxford Finance LLC) and is in the process of negotiating loan and security
documentation with Oxford pursuant to which such facility shall be provided (the “Senior Loan Refinancing”). 

  

	(D)	 The parties are entering into this Deed to (i) notify Novartis of the Senior Loan Refinancing and obtain
Novartis’ consent thereto (nowithstanding that such consent is not expressly required pursuant to the terms of the Note Instrument); and (ii) amend certain additional terms of the Note Instrument to add a mechanism for delivery of ADSs to
Novartis following a conversion of the Notes and remove provisions relating to AIM-listed status which will cease to be relevant after the Delisting. 

IT IS AGREED AS FOLLOWS: 
  

	1.	 INTERPRETATION 

Terms defined in the Note Instrument shall have the same meanings as given therein when used in this Deed unless otherwise defined herein. 

 

	2.	 AMENDMENTS AND CONSENT 

 

	2.1	 A new definition of “ADS” shall be added to clause 1.1 of the Note Instrument as of the
Effective Date, and read as follows: 

  

			
	ADS	  	means American Depositary Shares representing interests in the Ordinary Shares pursuant to a sponsored American Depositary Receipt facility with the
Depositary

			
	 2.2  A new definition of “ADS Exchange Ratio” shall be
added to clause 1.1 of the Note Instrument as of the Effective Date, and read as follows:

		
	ADS Exchange Ratio	  	means the ratio applicable to the exchange of Ordinary Shares for ADSs from time to time, currently being a ratio of 5 Ordinary Shares for each ADS
	
	 2.3  A new definition of “Depositary” shall be added to
clause 1.1 of the Note Instrument as of the Effective Date, and read as follows:

		
	Depositary	  	means the Depositary engaged by the Company for the issuance and transfer of ADSs
	
	 2.4  A new definition of “Issuance and Delivery
Instruction” shall be added to clause 1.1 of the Note Instrument as of the Effective Date, and read as follows:

		
	Issuance and Delivery Instruction	  	means an issuance and delivery instruction in such form as notified from the Company to the Noteholder from time to time, the current form of which is attached hereto at Schedule 4

  

	2.5	 Paragraph 3 of Part 1 of Schedule 3 to the Note Instrument shall, as of the Effective Date, be deleted in its
entirety and replaced with the following wording: 

  

	 	3.1	 The Conversion Notice shall set out, at a minimum: 

(a) the principal amount of Notes to be converted; 

(b) whether any accrued but unpaid interest on such principal amount is to be converted 

(c) the Conversion Date; and 

(d) whether the Ordinary Shares resulting from conversion are to be delivered as ADSs, 

 

	 	3.2	 If and to the extent that the Ordinary Shares issued are to be delivered as ADSs, the Noteholder shall be
required to deliver to the Company a completed Issuance and Delivery Instruction in the form set out in Schedule 4 (as such form may be amended from time to time by notice to the Noteholder) duly completed and executed by the Noteholder no later
than 3 Business Days following service of the relevant Conversion Notice on the Company. 

  

	 	3.3	 In the event of any failure by a Noteholder to deliver a duly completed Issuance and Delivery Instruction
within such time period the Company shall disregard such Noteholder’s request Noteholder for delivery of the relevant Ordinary Shares as ADSs and shall issue the number of Ordinary Shares specified in the Conversion Notice to the Noteholder on
the Conversion Date in accordance with paragraphs 1 to 5 of Part 2 of this Schedule 3. 

	2.6	 Paragraph 3 of Part 2 of Schedule 3 to the Note Instrument shall, as of the Effective Date, be deleted in its
entirety and replaced with the following wording: 

  

	 	3.	 The Conversion Shares shall be issued and allotted by the Company on the Conversion Date to:

 (a) the Noteholder; or 

(b) in the event that the Noteholder has required pursuant to paragraph 3.1 that the Ordinary Shares to be issued upon conversion are to be
delivered as ADSs and delivered a duly completed Issuance and Delivery Instruction, and there is an effective registration statement covering the Ordinary Shares to be issued on such exercise, issued to, deposited with (and otherwise registered in
the name of) the custodian (or its nominee) of the Depositary, and following such issuance and deposit the Company will direct the Depositary to issue an amount of ADSs via DTC (with such ADSs being eligible for listing on Nasdaq) in accordance with
the corresponding Issuance and Delivery Instruction; 
 and in each case the certificates for such Ordinary Shares shall be
dispatched to the persons entitled to them at their own risk. 
  

	2.7	 Paragraph 5 of Part 2 of Schedule 3 to the Note Instrument shall, as of the Effective Date, be deleted in its
entirety and replaced with the following wording: 

  

	 	5.1	 The entitlement of the Noteholder to a fraction of an Ordinary Share shall be rounded down to the nearest
whole number of Ordinary Shares which result from the conversion of the Notes and any accrued interest (if applicable). 

  

	 	5.2	 In the event that a Noteholder requires Ordinary Shares arising on conversion to be delivered as ADSs, the
entitlement of such Noteholder to ADSs shall be calculated using the ADS Exchange Ratio. No fractional ADSs will be issued, and any fractional entitlements to an ADS shall be issued to the relevant Noteholder in the form of Ordinary Shares in
accordance with Part 2 of this Schedule 3, rounded down to the nearest whole share. 

  

	2.8	 A new Schedule 4 shall, as of the Effective Date, be added to the Note Instrument in the form attached hereto
at Appendix 2. 

  

	2.9	 By their execution of this Deed Novartis hereby grant consent to 

 

	 	2.9.1	 the amendments to the Note Instrument included herein and the provisions of this Deed (including the
transactions contemplated herein); and 

  

	 	2.9.2	 the Senior Loan Refinancing (although such consent is not expressly required pursuant to the terms of the Note
Instrument and is requested by the Company solely for the purposes of keeping Novartis appraised of the details of the Senior Loan Refinancing). 

  

	3.	 MISCELLANEOUS 

 

	3.1	 This Deed shall be governed by and construed in accordance with English law and the parties submit to the
exclusive jurisdiction of the English courts. 

  

	3.2	 This Deed may be executed in counterparts which together shall constitute one document. 

 Appendix 1 

Note Instrument 

 Appendix 2 

ADS Issuance and Delivery Instruction 

[DATE] 
 Citibank, N.A., as Depositary 

388 Greenwich Street 
 New York, New York 10013 

Attn.: Mr. Brian M. Teitelbaum (brian.m.teitelbaum@citi.com) 

With a copy simultaneously delivered to: 
 Citibank, N.A., London
Branch 
 25 Canada Square 
 Canary Wharf 

London E14 5LB, England 
 Attn.: UK Custody Settlements 

Custody Team (uksettlements@citi.com) 
 Re: Issuance and Delivery
Instruction - Mereo BioPharma Group plc (CUSIP No.: 589492107) – Deposit & Hold 
 Dear Sirs: 

Reference is made to the Deposit Agreement, dated as of April 23, 2018, as amended and supplemented from time to time (the “Deposit
Agreement”), by and among Mereo BioPharma Group plc, a public limited company incorporated under the laws of England and Wales and its successors (the “Company”), Citibank, N.A., a national banking association organized and existing
under the laws of the United States of America, as Depositary (the “Depositary”), and all Holders and Beneficial Owners of American Depositary Shares (the “ADSs”) issued thereunder. All capitalized terms used, but not otherwise
defined herein, shall have the meaning assigned thereto in the Deposit Agreement. 
 In accordance with the terms and subject to the
limitations set forth in the Deposit Agreement, promptly following the Depositary’s receipt of confirmation from the Custodian that the Custodian has received a deposit of the number of Shares specified below made by the Company for the benefit
of the undersigned holder thereof (the “Holder” and together with the Company, the “Undersigned”), the Undersigned hereby jointly instruct the Depositary, and the Depositary hereby agrees: 

(i) to promptly accept for deposit the number of Shares and issue the number of ADSs as specified below: 

 

					
	Number of Shares deposited:	  	______________Shares	  	
			
	Number of ADSs (CUSIP No.: 589492107; each ADS representing five (5) Shares to be issued:	  		  	
			
		  	______________ADSs	  	

 and (ii) to promptly deliver such Program ADSs, as follows: 

 

					
	Name of DTC Participant to which the ADSs are to be delivered:	  	 	  	
			
	DTC Participant Account No.:	  	 	  	
			
	Account No. for recipient of ADSs at DTC Participant (f/b/o/ information):	  	 	  	

					
	Name on whose behalf the above number of ADSs are to be issued and delivered:	  	 	  	
			
	Contact person at DTC Participant:	  	 	  	
			
	Daytime telephone number of contact person at DTC:	  	 	  	

 The Company hereby confirms and certifies that (i) the registration statement on Form
F-3 (File No. 333-239708) (the “Registration Statement”), filed with the U.S. Securities and Exchange Commission (the “Commission”) on
July 6, 2020, registers the resale of the above Shares represented by ADSs, such ADSs will be freely transferable following the issuance thereof by the Depositary, and there are no legal restrictions on subsequent transfers of the ADSs to be
issued hereunder under the laws of England and Wales or the United States, (ii) the Registration Statement is effective under the Securities Act of 1933, as amended (the “Securities Act”), and (iii) no stop order suspending the
effectiveness of the Registration Statement has been issued and no proceedings for such purpose have been instituted or are pending or, to the best knowledge of the Company, are contemplated or threatened by the Commission. 

The Holder hereby represents and covenants to, and for the benefit of, the Depositary and Citibank, N.A.—London Branch (the “Custodian”), that
(i) the Holder is not an “affiliate” of the Company as that term is defined in Rule 144 promulgated by the Commission under the Securities Act and has not been an affiliate at any time during the 90 days immediately preceding the date
hereof, and (ii) all stamp duty taxes, including, without limitation, the U.K. Stamp Duty Reserve Tax (“SDRT”), will be paid in full and on a timely basis to the extent such taxes are payable in respect of the deposit of the Shares
and the issuance and delivery of the ADSs as contemplated herein. 
 Each of the Holder and, to the extent it is not unlawful for the Company to do so under
the applicable laws of England and Wales, the Company agrees to indemnify the Depositary and the Custodian for, and to hold the Depositary and the Custodian harmless against, all losses, liabilities, taxes, charges, penalties or expenses (including
reasonable legal fees and disbursements), incurred by the Depositary and/or by the Custodian or to which the Depositary and/or the Custodian may become subject to and arising directly or indirectly from the failure by any person to pay (or
discharge) any applicable stamp duty taxes, including, without limitation, SDRT, or any other similar duty or tax in connection with the deposit of the Shares and the issuance and delivery of the ADSs as contemplated herein, save to the extent that
such losses, liabilities, taxes, charges, penalties or expenses are due to the negligence or bad faith of the Custodian or the Depositary. 
  

									
	[HOLDER]	 		  	MEREO BIOPHARMA GROUP PLC
					
	By: 	 	 	 		  	By: 	  	 
	Name:	 		 		  	Name:	  	
	Title:	 		 		  	Title:	  	

 IN WITNESS WHEREOF this agreement has been executed as a deed and delivered by the parties on the
date first above written. 
  

					
	 Executed and delivered
 as a DEED by
MEREO BIOPHARMA GROUP PLC acting by DENISE SCOTS-KNIGHT, a director and CHARLES SERMON, its secretary
	  	 	  	 Director

			
		  	 	  	 Secretary

			
	 Executed and delivered
 as a DEED by
NOVARTIS PHARMA AG acting by MARC CEULEMANS and MATT OWENS who, in accordance with the laws of Switzerland, are acting under the authority of the company
	  	 	  	 Authorised Signatory

			
		  	 	  	 Authorised SignatoryEX-4.31

 Exhibit 4.31 

DEED OF CONSENT AND AMENDMENT TO WARRANT INSTRUMENT 

THIS DEED is dated 24 November 2020 (such date being the “Effective Date”) 

BETWEEN: 
  

	(1)	 MEREO BIOPHARMA GROUP PLC, a public limited company incorporated in England and Wales with company
number 04206001 whose registered office is at 4th Floor, One Cavendish Place, London, England W1G 0QF (the “Company”); and 

  

	(2)	 NOVARTIS PHARMA AG, a company incorporated and registered in Switzerland whose registetered office is at
Postfach, 4002 Basel Switzerland (“Novartis”). 

 WHEREAS 

 

	(A)	 The Company adopted a warrant instrument on 10 February 2020, a copy of which is appended hereto as
Appendix 1 (the “Warrant Instrument”) constituting certain warrants to subscribe for Ordinary Shares in the capital of the Company. 

  

	(B)	 The Company is intending to cancel the admission to trading of its Ordinary Shares from the Alternative
Investment Market (“AIM”) operated by the London Stock Exchange, with effect from 18 December 2020 (the “Delisting”). Following the Delisting, the only listing maintained by the Company will be that of American
depositary receipts on NASDAQ, the tradeable entitlement representing American Depositary Shares (“ADSs”), each of which such ADS represents five Ordinary Shares of £0.003 in the capital of the Company. 

 

	(C)	 The parties are entering into this Deed to (i) confirm that the Company has duly notified Novartis of the
Delisting as required by clause 11.1.3 Warrant Instrument; and (ii) amend certain additional terms of the Warrant Instrument to add a mechanism for delivery of ADSs to a Warrantholder following a valid exercise of subscription rights and remove
provisions relating to AIM-listed status which will cease to be relevant after the Delisting. 

IT IS AGREED AS FOLLOWS: 
  

	1.	 INTERPRETATION 

Terms defined in the Warrant Instrument shall have the same meanings as given therein when used in this Deed unless otherwise defined herein.

  

	2.	 AMENDMENTS AND CONSENT 

 

	2.1	 A new definition of “ADS” shall be added to clause 1.1 of the Warrant Instrument as of the
Effective Date, and read as follows: 

  

			
	ADS	  	means American Depositary Shares representing interests in the Ordinary Shares pursuant to a sponsored American Depositary Receipt facility with the Depositary;

 The definition of “CREST” in clause 1.1 of the Warrant Instrument shall, as of the
Effective Date, be deleted in its entirety and replaced with the following wording:  
 [Not used] 

	2.2	 A new definition of “Depositary” shall be added to clause 1.1 of the Warrant Instrument as of
the Effective Date, and read as follows: 

  

			
	Depositary	  	means the Depositary engaged by the Company for the issuance and transfer of ADSs;

  

	2.3	 A new definition of “Issuance and Delivery Instruction” shall be added to clause 1.1 of the
Warrant Instrument as of the Effective Date, and read as follows: 

  

			
	Issuance and Delivery Instruction	  	means an issuance and delivery instruction in such form as notified from the Company to the Warrantholders from time to time, the current form of which is attached hereto at Schedule 3;

  

	2.4	 Clause 6.2 of the Warrant Instrument shall, as of the Effective Date, be deleted in its entirety and replaced
with the following wording: 

  

	 	6.2	 In order to exercise its Subscription Rights validly, a Warrantholder must deliver the following items to
the registered office of the Company: 

  

	 	6.2.1	 the Warrant Certificate for the Warrants in respect of which the Subscription Rights are being exercised,
together with the Notice of Subscription duly completed; 

  

	 	6.2.2	 if required pursuant to clause 6.3.1, a remittance by banker’s draft, drawn on a UK clearing bank, (or
such other mode of payment as the Company and the Warrantholder shall agree); 

  

	 	6.2.3	 the name and address of the Warrantholder to which the Warrant Shares arising on an exercise of Subscription
Rights are to be issued (or, if such shares are to be delivered as ADSs, the name and address of the custodian (or its nominee) of the Depositary; 

  

	 	6.2.4	 if and to the extent that the Ordinary Shares issued are to be delivered as ADSs, a completed Issuance and
Delivery Instruction in the form set out at Schedule 3 hereto (as such form may be amended from time to time by notice to the Warrantholder) duly completed and executed by the Warrantholder. 

 

	2.5	 Clause 6.3 of the Warrant Instrument shall, as of the Effective Date, be deleted in its entirety and replaced
with the following wording: 

 6.3.1 The Subscription Price for each of the Warrant Shares shall be made to such account
as is notified by the Company within 3 Business Days of the relevant Notice of Subscription delivered pursuant to clause 6.2.1 and no Warrant Shares shall be issued to the Warrantholder (or, in the case of Ordinary Shares to be delivered as ADSs,
issued to the custodian (or its nominee) of the Depositary) until the aggregate Subscription Price has been satisfied. 
 6.3.2 In the
event of any failure by a Warrantholder to deliver a duly completed Issuance and Delivery Instruction within 3 Business Days of delivering its Notice of Subscription, the Company shall disregard the Warrantholder’s request for delivery of the
relevant Ordinary Shares as ADSs and shall issue the number of Ordinary Shares specified in the Conversion Notice to the Warrantholder on the Conversion Date in accordance with paragraph 2 of this Part 2 of Schedule 2. 

	2.6	 A new Clause 6.4 shall, as of the Effective Date, be added to the Warrant Instrument and read as
follows: 

  

	 	6.4	 In the event that a Warrantholder requires Ordinary Shares arising on conversion to be delivered as ADSs,
the entitlement of such Warrantholder to ADSs shall be calculated using the ADS Exchange Ratio. No fractional ADSs will be issued, and any fractional entitlements to an ADS shall be issued to the relevant Warrantholder in the form of Ordinary Shares
in accordance with clauses 6 and 8 of this instrument, rounded down to the nearest whole share. 

  

	2.7	 Clause 7.1 of the Warrant Instrument shall, as of the Effective Date, be deleted in its entirety and replaced
with the following wording: 

  

	 	7.1	 Following a valid exercise of Subscription Rights by a Warrantholder, the Company shall in accordance with
clause 7.3: 

  

	 	7.1.1	 allot and issue credited as fully paid the Warrant Shares to which the Warrantholder is entitled by
exercising the Subscription Rights (the “Allotted Shares”) to: 

 (i) the
Warrantholder (or to its nominee or trustee as notified to the Company in the Notice of Subscription); or 
 (ii) in the event that
the Warrantholder has required pursuant to clause 6.2 that Ordinary Shares to be issued from the Exercise of Subscription Rights are to be delivered as ADSs and delivered a duly completed Issuance and Delivery Instruction, and there is an effective
registration statement covering the Ordinary Shares to be issued on such exercise, issue to, deposit with (and otherwise register in the name of) the custodian of the Depositary (or its nominee), and following such issuance and deposit the Company
will direct the Depositary to issue an amount of ADSs via DTC (with such ADSs being eligible for listing on Nasdaq) in accordance with the corresponding Issuance and Delivery Instruction; 

 

	 	7.1.2	 immediately following allotment and issue in accordance with clause 7.1.1, enter, or procure that the
Company’s Registrars enter (i) the Warrantholder’s name (or its nominee’s or trustee’s name) or (ii) in the case of any Ordinary Shares to be delivered as ADSs, the name of the custodian (or its nominee) of the
Depositary in the register of members of the Company as the holder of the Allotted Shares; 

  

	 	7.1.3	 immediately following registration in accordance with clause 7.1.2, send either to the person identified by
the Warrantholder pursuant to clause 7.1.1 or the custodian (or its nominee) of the Depositary, free of charge, share certificate(s) in respect of the Allotted Shares; 

 

	 	7.1.4	 apply for the admission of the Warrant Shares to trading on any recognised investment exchange on which the
Warrant Shares are listed at the time of the allotment and issue pursuant to clause 7.1.1, and shall use its reasonable endeavours to secure such admission to trading no later than ten (10) Business Days after such application.

  

	2.8	 Clause 12.1.4 of the Warrant Instrument shall, as of the Effective Date, be deleted in its entirety and
replaced with the following wording: 

 [Not used] 

	2.9	 The Schedule to the Warrant Certificate (Notice of Subscription) at Schedule 1 of the Warrant Instrument
shall, as of the Effective Date be deleted in its entirety and replaced with the form attached hereto at Appendix 2. 

  

	2.10	 A new Schedule 3 shall, as of the Effective Date, be added to the Warrant Instrument in the form attached
hereto at Appendix 3. 

  

	2.11	 For the purposes of clause 9.1 of the Warrant Instrument, by their execution of this Deed, Novartis hereby
grant Consent to the amendments herein and the provisions of this Deed (including the transactions contemplated herein). 

  

	2.12	 For the purposes of clause 11.1.3 of the Warrant Instrument, by their execution of this Deed, Novartis hereby
confirms that it has been duly notified by the Company of the intention to cancel the admission to trading of the Ordinary Shares on AIM. 

  

	3.	 MISCELLANEOUS 

 

	3.1	 This Deed shall be governed by and construed in accordance with English law and the parties submit to the
exclusive jurisdiction of the English courts. 

  

	3.2	 This Deed may be executed in counterparts which together shall constitute one document. 

 Appendix 1 

Warrant Instrument 

 Appendix 2 

Notice of Subscription 
 To:
        The Directors 
 MEREO BIOPHARMA GROUP PLC (“Company”) 

This notice is issued pursuant to the warrant instrument issued by the Company on 10 February 2020 (“Warrant Instrument”). Words and
expressions used in this notice which are defined in the Warrant Instrument have the meanings given to them in the Warrant Instrument. 
 We hereby
irrevocably elect to exercise [number] Warrants issued to us by the Company pursuant to the Warrant Instrument and purchase thereunder (and surrender herewith the relevant warrant certificate) as follows: 

(1) 
 (A) ______ Warrant Shares to be issued to the
Warrantholder (or its nominee or trustee) as Ordinary Shares pursuant to the Warrant Instrument; 
 (B) ______ Warrant Shares to be issued to the custodian
of the Depositary for delivery to the Warrantholder as ADSs pursuant to the Warrant Instrument. 
 (2) We hereby confirm that we will procure payment in the
sum of £[amount] being the aggregate Subscription Price for such Warrant Shares. 
 We direct the Company: 

[use for a request under option (1)(A) above] to issue [number] of Ordinary Shares to be issued pursuant to this exercise in the following
numbers to the following proposed allottees, each of which is either a Warrantholder, a nominee or trustee of a Warrantholder or a transferee of one of those persons approved in accordance with clause 8.1 of the Warrant Instrument] 

 

									
	 Number/percent age of

shares
	  	Name of proposed allottee	 	  	Address of proposed allottee	 
	 1
	  				  			

 [OR] use for a request under option (1)(B) above] to issue, allot, and deposit [number] of Ordinary
Shares to be issued pursuant to this exercise to the custodian (or its nominee) of the Depositary and that following such issuance and deposit, to direct the Depositary to issue an amount of ADSs via DTC in accordance with the Issuance and Delivery
Instruction corresponding to this Notice of Subscription. 

 The Warrantholder represents and warrants that this Notice of Subscription has been duly signed and
constitutes a valid and binding act to exercise the said Warrants. 
  

	
	 Place and date:

	
	 Name of Warrantholder:

	
	
                   
                                         
                    

	 By:

	
	 Title:

	
	 The above exercise is acknowledged and accepted. Place and date:

	
	 MEREO BIOPHARMA GROUP PLC

	
	
                   
                                         
                    

	 By:

	
	 Title:

 Appendix 3 

ADS Issuance and Delivery Instruction 

[DATE] 
 Citibank, N.A., as Depositary 

388 Greenwich Street 
 New York, New York 10013 

Attn.: Mr. Brian M. Teitelbaum (brian.m.teitelbaum@citi.com) 

With a copy simultaneously delivered to: 
 Citibank, N.A., London
Branch 
 25 Canada Square 
 Canary Wharf 

London E14 5LB, England 
 Attn.: UK Custody Settlements 

Custody Team (uksettlements@citi.com) 
 Re: Issuance and Delivery
Instruction—Mereo BioPharma Group plc (CUSIP No.: 589492107) – Deposit & Hold 
 Dear Sirs: 

Reference is made to the Deposit Agreement, dated as of April 23, 2018, as amended and supplemented from time to time (the “Deposit
Agreement”), by and among Mereo BioPharma Group plc, a public limited company incorporated under the laws of England and Wales and its successors (the “Company”), Citibank, N.A., a national banking association organized and existing
under the laws of the United States of America, as Depositary (the “Depositary”), and all Holders and Beneficial Owners of American Depositary Shares (the “ADSs”) issued thereunder. All capitalized terms used, but not otherwise
defined herein, shall have the meaning assigned thereto in the Deposit Agreement. 
 In accordance with the terms and subject to the
limitations set forth in the Deposit Agreement, promptly following the Depositary’s receipt of confirmation from the Custodian that the Custodian has received a deposit of the number of Shares specified below made by the Company for the benefit
of the undersigned holder thereof (the “Holder” and together with the Company, the “Undersigned”), the Undersigned hereby jointly instruct the Depositary, and the Depositary hereby agrees: 

(i) to promptly accept for deposit the number of Shares and issue the number of ADSs as specified below: 

 

					
	Number of Shares deposited:	  	______________Shares	  	
			
	Number of ADSs (CUSIP No.: 589492107; each	  		  	
	ADS representing five (5) Shares to be issued:	  		  	
	 	  	______________ADSs	  	 

 and (ii) to promptly deliver such Program ADSs, as follows: 

 

					
	Name of DTC Participant to which the ADSs are to be delivered:	  	 	  	
			
	DTC Participant Account No.:	  	 	  	
			
	Account No. for recipient of ADSs at DTC Participant (f/b/o/ information):	  	 	  	

					
	Name on whose behalf the above number of ADSs are to be issued and delivered:	  	 	  	
			
	Contact person at DTC Participant:	  	 	  	
			
	Daytime telephone number of contact person at DTC:	  	 	  	

 The Company hereby confirms and certifies that (i) the registration statement on Form
F-3 (File No. 333-239708) (the “Registration Statement”), filed with the U.S. Securities and Exchange Commission (the “Commission”) on
July 6, 2020, registers the resale of the above Shares represented by ADSs, such ADSs will be freely transferable following the issuance thereof by the Depositary, and there are no legal restrictions on subsequent transfers of the ADSs to be
issued hereunder under the laws of England and Wales or the United States, (ii) the Registration Statement is effective under the Securities Act of 1933, as amended (the “Securities Act”), and (iii) no stop order suspending the
effectiveness of the Registration Statement has been issued and no proceedings for such purpose have been instituted or are pending or, to the best knowledge of the Company, are contemplated or threatened by the Commission. 

The Holder hereby represents and covenants to, and for the benefit of, the Depositary and Citibank, N.A.—London Branch (the “Custodian”), that
(i) the Holder is not an “affiliate” of the Company as that term is defined in Rule 144 promulgated by the Commission under the Securities Act and has not been an affiliate at any time during the 90 days immediately preceding the date
hereof, and (ii) all stamp duty taxes, including, without limitation, the U.K. Stamp Duty Reserve Tax (“SDRT”), will be paid in full and on a timely basis to the extent such taxes are payable in respect of the deposit of the Shares
and the issuance and delivery of the ADSs as contemplated herein. 
 Each of the Holder and, to the extent it is not unlawful for the Company to do so under
the applicable laws of England and Wales, the Company agrees to indemnify the Depositary and the Custodian for, and to hold the Depositary and the Custodian harmless against, all losses, liabilities, taxes, charges, penalties or expenses (including
reasonable legal fees and disbursements), incurred by the Depositary and/or by the Custodian or to which the Depositary and/or the Custodian may become subject to and arising directly or indirectly from the failure by any person to pay (or
discharge) any applicable stamp duty taxes, including, without limitation, SDRT, or any other similar duty or tax in connection with the deposit of the Shares and the issuance and delivery of the ADSs as contemplated herein, save to the extent that
such losses, liabilities, taxes, charges, penalties or expenses are due to the negligence or bad faith of the Custodian or the Depositary. 
  

									
	[HOLDER]	 		  	MEREO BIOPHARMA GROUP PLC
					
	By: 	 	 	 		  	By: 	  	 
	Name:	 		 		  	Name:	  	
	Title:	 		 		  	Title:	  	

 IN WITNESS WHEREOF this agreement has been executed as a deed and delivered by the parties on the
date first above written. 
  

					
	 Executed and delivered
 as a DEED by
MEREO BIOPHARMA GROUP PLC acting by DENISE SCOTS-KNIGHT, a director and CHARLES SERMON, its secretary
	  	 	  	 Director

			
		  	 	  	 Secretary

			
	 Executed and delivered
 as a DEED by
NOVARTIS PHARMA AG acting by MARC CEULEMANS and MATT OWENS who, in accordance with the laws of Switzerland, are acting under the authority of the company
	  	 	  	 Authorised Signatory

			
		  	 	  	 Authorised Signatory

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00325-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00325-of-00352.parquet"}]]