Document:

Form of Certificate Account Opening and Maintenance Agreement

 Exhibit 10.30 
 CERTIFICATE ACCOUNT OPENING AND MAINTENANCE AGREEMENT 
 This Certificate
Account Opening and Maintenance Agreement (the “Agreement”) is made by and between LC Trust I, a Delaware statutory trust (the “Trust”), LendingClub Corporation, a Delaware corporation (the “Company”) and
                    , a                      (the
“Investor” or “Purchaser”), effective as of                      (the “Effective Date”). 

RECITALS 
 A. In
connection with this Agreement, the Investor has agreed to execute a Series Supplement with the Trust in order to acquire a master global trust certificate (the “Certificate”) from the Trust through which the Investor may invest in certain
member loans originated and available for investment through the Company’s primary platform (the “Platform”). 
 B. In order to
participate through the Platform in connection with its Certificate, the Investor requires accounts with the Company and Millennium Trust Company (“Millennium”), the custodian for the Trust. 

C. The Investor will use the Company’s existing Platform to execute its investment orders. 

NOW, THEREFORE, the parties hereto, in consideration of the mutual covenants, agreements, terms and conditions contained herein, the
sufficiency and receipt of which are hereby acknowledged, agree as follows: 
 1. Certificate Account Opening. 

1.1. The Investor hereby confirms its agreement to execute a Series Supplement with the Trust and acquire a Certificate for the purpose
of investing in consumer member loans originated through the Company’s Platform in connection with the Company’s Standard Program (as defined in connection with the Private Placement Memorandum for LC Trust I Trust Certificates dated
October 6, 2014)(“Loans”). 
 1.2. Pursuant to its acquisition of a Certificate, the Investor shall complete and
provide to the Trust the Certificate Purchaser Information Form attached hereto as Appendix A (the “Purchaser Information Form”). The Investor agrees to complete all fields presented on the Purchaser Information Form, except that Investors
that are individuals are not required to complete fields that are marked “Entities only” and that Investors that are entities are not required to complete fields that are marked “Individuals,” and to sign and date such Form and
return such Form to the Trust. The Investor further agrees to provide to the Trust such supplemental information and materials as the Trust may reasonably request in connection with the Investor’s responses to the Purchaser Information Form.

 1.3. Pursuant to its acquisition of a Certificate, the Investor hereby authorizes and directs the Trust to take all steps
required to open an account with the Company (the “Account”) on the Investor’s behalf to enable the Investor to invest in Loans originated through and presented on the Platform. The Investor further authorizes and directs the Trust to
release and provide to the Company such information 

  
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regarding the Investor as may be required or reasonably requested by the Company to enable the Company to establish and maintain the Account on behalf of the Investor, including but not
necessarily limited to the information set forth on the Purchaser Information Form. The Investor acknowledges and agrees that the opening of the Account on the Investor’s behalf is contingent upon (1) Investor acquiring a Certificate
pursuant to a validly executed Series Supplement and (2) Investor providing a completed and signed Purchaser Information Form, plus such supplemental information and materials as the Trust may request, to the Trust. The Investor agrees to
provide to the Trust and/or the Company any additional information or materials required by the Company to allow the Company to establish and maintain the Account. 
 1.4. The Trust hereby authorizes and directs the Company to open the Account on behalf of the Investor. The Trust agrees to provide such information regarding the Investor as the Company may require or
reasonably request to enable the Company to establish and maintain the Account on behalf of the Investor. The Company agrees to establish the Account pursuant to the Trust’s direction and to maintain the Account while this Agreement remains in
effect. Nothing herein shall obligate the Company to continue to maintain the full functionality of the Account following termination of this Agreement. 
 1.5. By execution of this Agreement, the Investor agrees to, accepts and acknowledges receipt of and agreement with the Company’s Terms of Use, privacy policy and other necessary account opening
documentation. 
 2. Account Functionality, Funding and Investment. 

2.1. Subject to the terms and conditions of this Agreement, by opening and maintaining the Account on behalf of the Investor, the Company
will provide to the Investor the opportunity to: 
 (a) review requests for Loans that the Company has received from its
members; and 
 (b) invest in any such Loans, on a fractional basis in increments of $25 or (if applicable) for the total
amount of such Loan. 
 2.2. The Investor will only use the Company’s Platform to execute its investment decisions. For the
avoidance of doubt, for purposes of this Agreement, the use of the Company’s Application Program Interface (API) in connection with the execution of investment decisions shall be deemed the use of the Company’s Platform, provided that any
such use of the API is consistent with any agreement between the Company and Investor governing Investor’s use of the API. 

2.3. Investor acknowledges and agrees that the Account may only be used to acquire and hold Loans through the Certificate. The Account
may not be used to acquire or hold any other types of securities, including, but not limited to, Member Payment Dependent Notes issued by the Company. Investor further acknowledges and agrees with Company that the opening of a new account with the
Company, including execution of a new Series Supplement with the Trust and the acquisition of a new Certificate, would be required in order for Investor to invest in any types of loans originated through the Platform other than Loans. 

  
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 2.4. In order to invest in a Loan, the Investor must have sufficient capital in a custodial
account (the “Custodial Account”) in its name with Millennium corresponding to the Account at the time any investment corresponding to a Loan is to be executed. All funds required for the settlement of investment transactions in Loans will
be debited and released from such Custodial Account as further described in Paragraph 2.5 below. Investor acknowledges and agrees that it bears sole responsibility for funding such Custodial Account by remitting funds to Millennium in accordance
with Millennium’s instructions for funding such account. Investor represents, warrants and covenants that it will always maintain sufficient capital in such Custodial Account in order to effect any desired investment transactions. 

2.5. Once the Investor has selected a Loan for investment via the Platform (a “Purchase Commitment”), the Investor may not
revoke that commitment. A Purchase Commitment is an irrevocable commitment to invest in a Loan, provided that the Loan becomes issued. The Investor agrees and acknowledges that it will not have access to any funds committed to a Loan as the result
of a Purchase Commitment unless and until the Company has notified the Investor that the Loan will not be issued. Funds previously committed to a Loan that does not issue will be released to the Investor’s Custodial Account and made available
for investment. Investment transactions are irrevocable regardless of whether the full amount of the Loan request is funded, and the Investor assumes all risk related thereto. 
 2.6. Investor acknowledges and agrees that the Company may, in the Company’s sole and absolute discretion, impose a limit on the aggregate amount of Loans that Investor may purchase through the
Certificate and/or Account in a given month (a “Purchase Limitation”). If the Company wishes to impose such a limit, the Company will provide Investor thirty days’ prior written notice (which notice may be, but is not required to be,
conveyed via electronic mail), informing Investor of the total aggregate dollar limit of Loan purchases through the Certificate and/or Account that the Company will accept on behalf of Investor. Once thirty days have elapsed following the date of
any such notice, the Purchase Limitation relating to such notice will go into effect on the first day of the following calendar month, and will apply for each month thereafter until the Company provides notice that the Purchase Limitation has been
modified or lifted. If a Purchase Limitation is in place, Investor will not be permitted to purchase Loans in an amount in excess of the Purchase Limitation without prior approval of the Company, which approval may be withheld in the Company’s
sole and absolute discretion. 
 2.7. Investor agrees that it will refrain from purchasing more than 25% (the “Cap”)
of any single Loan listed via the Platform for the first four (4) days after such Loan is initially listed. After the first four (4) days after a Loan’s initial listing, Investor will be free to invest in such Loan without regard to
the Cap. 
 3. Loan Issuance and Custody. 
 3.1. Loans will generally issue at the end of the 14-day posting period during which the Loan is available for investment through the Platform unless (i) the Loan is declined prior to issuance, in
which case the Investor’s investment commitment will be released as described above; (ii) investor commitments for the entire amount of the Loan request have been received earlier and any verification or other operational processes have
been completed, in which case the Loan will issue earlier; or (iii) the Loan request is declined or withdrawn for any reason. 

  
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 3.2. The Loans invested in by Investor will be acquired and held by the Trust and accounted
for on the Trust’s books and records as relating to the Certificate. The Loans and the Certificate, with respect to which payments will be dependent upon repayment of the underlying Loans, will be subject to the terms of the Amended and
Restated Trust Agreement, the Private Placement Memorandum, the Series Supplement, the Terms and Conditions to Global Certificates Issued by LC Trust I, the Amended and Restated Purchase Agreement, and the Amended and Restated Service Agreement,
each as currently in effect, and as may be amended from time to time (collectively, the “Trust Documents”). 
 3.3.
Loans acquired and held by the Trust will be maintained by Millennium as custodian pursuant to, and subject to the terms of, that certain Custodial Account Agreement between the Trust and Millennium. Investor acknowledges and agrees that no direct
custodial relationship between Investor and Millennium is created by operation of such agreement, the agreement by and between the Company and Millennium, this Agreement, or any other agreement other than agreements to which both the Investor and
Millennium are parties. Investor further acknowledges and agrees that it bears sole responsibility for entering into an agreement with Millennium pertaining to the custody of its Certificate and the opening of a Custodial Account, and that the
opening and maintenance of the Account under this Agreement is contingent upon Investor’s entering into such an agreement with Millennium and opening and maintaining a Custodial Account. Investor acknowledges and agrees that the Trust may, in
its discretion, request confirmation from the Investor and/or Millennium that a Custodial Account has been opened in the Investor’s name prior to opening an Account with the Company on the Investor’s behalf. 

4. Fees. In consideration of the services to be provided by the Company in connection with this Agreement and the Account, Investor agrees to pay
to the Company certain fees as provided in Appendix B attached hereto. Unless otherwise provided on such Appendix B, fees shall accrue for each month in which the value of Investor Custom Program Loans is greater than zero on any calendar day of
such month, shall be calculated based on the value of the assets in the Account as of the last calendar day of such month, and shall be payable monthly in arrears. 
 5. Covenants and Acknowledgements. The Investor represents, warrants, covenants and acknowledges that: 
 5.1. it has no right to, and will not make any attempt, directly or through any third party, to collect on any Loan; 
 5.2. borrower members may default on their payment obligations under the Loans and any such default will reduce the amounts, if any, it may receive under the terms of the Certificate, and Company makes no
representations as to the correctness of any information provided by borrower members; 
 5.3. borrower members may pre-pay
their payment obligations under the Loans without penalty and that any such prepayment may reduce the amounts, if any, it may receive under the terms of the Certificate; 
 5.4. it has the power to enter into and perform its obligations under this Agreement; 

  
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 5.5. it is duly organized, validly existing and in good standing in the jurisdiction set
forth above, and will maintain such status at all times during the term of this Agreement; 
 5.6. this Agreement has been duly
authorized, executed and delivered by it; 
 5.7. it has received and reviewed the Trust Documents; 

5.8. it has complied in all material respects with applicable federal, state and local laws; 

5.9. it is acquiring the Certificate for its own account and is not acquiring such Certificate with a view toward resale or distribution,
as such term is defined in connection with the federal securities laws and regulations thereunder; 
 5.10. it has been advised
that neither the Certificate nor the offering of the Certificate has been registered under the Securities Act of 1933 (the “Securities Act”) or applicable state securities laws, but is being offered and sold pursuant to exemptions from
such laws. The Trust and the Company are relying in part on the Investor’s representations and warranties contained in this Paragraph and Appendix A to this Agreement for the purpose of qualifying for such exemptions from registration.
Accordingly, the Investor hereby represents and warrants that it is an “accredited investor” as indicated by its responses to Appendix A, and agrees to provide any additional documents and information that the Trust or Company may
reasonably request for purposes of determining the Investor’s status as an accredited investor; 
 5.11. its interest in
the Trust’s offering of Certificates did not result from its review of the registration statement filed by the Company with the U.S. Securities and Exchange Commission in connection with the Company’s public offering of Member Payment
Dependent Notes, and it initially learned of the Trust’s offering of Certificates via other means; 
 5.12. it is aware
that its rights to transfer the Certificate are restricted by the Securities Act, applicable state securities laws and laws of other jurisdictions, the Series Supplement, the Terms and Conditions to Global Certificates, and the absence of a market
for the Certificate, among other factors. The Investor further understands that (i) Certificates will not be registered under the Securities Act; (ii) there will be no public market for Certificates; (iii) the Investor may not be able
to avail itself of exemptions available for resale of the Certificate without registration, and accordingly, may have to hold the Certificate indefinitely; and (iv) it may not be possible for the Investor to liquidate its position in the
Certificate; and 
 5.13. it has made and will make its decisions in connection with its consideration of any loan requests on
the Platform in compliance with the Equal Credit Opportunity Act, 15 U.S.C. 1601 et seq., and its implementing Regulation B, 12 C.F.R. 202 et seq., as such may be amended from time to time, and all applicable state or local laws, regulations, rules
or ordinances, including but not limited to all such laws, regulations, rules or ordinances concerning credit discrimination. 

  
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 6. Company Representations and Warranties. Company represents and warrants to the Investor that:

 6.1. it is duly organized, validly existing as a corporation and in good standing under the laws of Delaware and has
corporate power to enter into and perform its obligations under this Agreement; 
 6.2. this Agreement has been duly authorized,
executed and delivered by the Company; and 
 6.3. it has made commercially reasonable efforts to verify the identity of the
borrower members obligated on the Loans. 
 7. No Advisory Relationship. The Investor agrees and acknowledges that it is acting in a
self-directed manner in determining and requesting its investments in Loans and that it is not requesting, receiving or relying upon the advice of the Trust, the Company or any subsidiary, affiliate, employee, contractor, officer, stockholder,
director or agent of the Company (collectively, the “Representatives”), and that such parties are not acting as the Investor’s agent, fiduciary or adviser. Investor confirms that it is not relying on any representation, warranty, or
communication (whether written or oral) of the Trust, the Company or any of the Representatives as investment advice or as a recommendation to purchase Loans or any particular Loan, and that any decision to invest in such Loans or any particular
Loan is made by Investor in its sole and absolute discretion. Investor further agrees and acknowledges that neither the Trust, the Company nor any Representative has the discretion or authority to change or modify any requested investment
transaction. Moreover, the Investor agrees and represents that it is not entering into this Agreement with the intent or expectation that the Representatives would act in any fiduciary or advisory capacity and specifically requests that the
Representatives not act in such capacity. The Trust, the Company and the Representatives assume no advisory or fiduciary responsibility in the Investor’s favor in connection with the purchase of the Certificate or self-directed investments in
Loans, and the Trust, the Company and its Representatives have not provided the Investor with any legal, accounting, investment, financial planning, regulatory or tax advice with respect to the Loans. Investor has consulted its own legal,
accounting, investment, financial planning, regulatory and tax advisors to the extent deemed necessary or appropriate. 
 8. Limitations on
Damages. INVESTOR EXPRESSLY UNDERSTANDS AND AGREES THAT NEITHER THE TRUST, THE COMPANY NOR ANY OF THE REPRESENTATIVES SHALL BE LIABLE TO INVESTOR FOR ANY DAMAGES, DIRECT OR INDIRECT, RESULTING FROM ANY TRANSACTIONS UNDERTAKEN BY INVESTOR OR
ANYONE ACTING ON INVESTOR’S BEHALF IN THE ACCOUNT, TRANSACTIONS THAT FAIL TO BE UNDERTAKEN BY INVESTOR OR ANYONE ACTING ON INVESTOR’S BEHALF IN THE ACCOUNT, ANY OTHER MATTER RELATING TO OR ARISING FROM INVESTOR ACTIONS OR FAILURES TO ACT
WITH RESPECT TO THE ACCOUNT, INVESTMENT IN LOANS, FAILURE TO INVEST IN LOANS, OR ANY DECISIONS OR OUTCOMES BASED ON ANY OF THE FOREGOING. IN NO EVENT SHALL THE TRUST, THE COMPANY OR THE REPRESENTATIVES BE LIABLE TO THE INVESTOR FOR ANY LOST PROFITS,
PRINCIPAL, DATA OR OTHER LOSSES, OR ANY SPECIAL, INCIDENTAL, EXEMPLARY, CONSEQUENTIAL OR PUNITIVE DAMAGES, EVEN IF INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. FURTHERMORE, THE TRUST AND THE COMPANY DO NOT MAKE ANY REPRESENTATION OR WARRANTY TO THE
INVESTOR REGARDING THE EFFECT THAT THIS AGREEMENT MAY HAVE UPON THE FOREIGN, FEDERAL, STATE OR LOCAL TAX LIABILITY OF THE INVESTOR. 

  
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 9. Indemnity. The Investor agrees to fully indemnify and hold harmless the Trust, the Company and the
Representatives from and against any claim (third-party or otherwise) arising from or related any transactions undertaken in or otherwise for the benefit of the account, transactions that fail to be undertaken in or otherwise for the benefit of the
account, any other matter relating to or arising from investor actions or failures to act with respect to the account, investment in Loans, failure to invest in Loans, or any decisions or outcomes based on any of the foregoing, and any claim made by
the Investor, any beneficial owners or affiliates of the Investor, or any person claiming through the Investor arising from or related to any alleged breach of a fiduciary duty or a claimed advisory relationship, in all cases including any liability
or expense arising from all claims, losses, damages (actual and consequential) and actual or threatened suits and judgments (including litigation costs and attorneys’ fees), except to the extent any such claims, losses or damages directly arise
from conduct that is finally determined to amount to gross negligence (determined in accordance with Delaware law) or willful misconduct on the part of the Trust, the Company, or a Representative. 

10. Section 1542. The Investor waives any benefits of Section 1542 of the Civil Code of the State of California, or any similar
provision of common law, which provides as follows: 
 “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES
NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.” 
 11. Claims. To the fullest extent permitted by law, at no time subsequent to the execution of this Agreement will the Investor (or any heir, spouse, successor, agent, etc.) pursue, or cause or
knowingly permit the prosecution of, or assist, in any state, federal or foreign court, or before any local, state, federal or foreign administrative agency, or any other tribunal, any charge, claim or action of any kind, nature and character
whatsoever, known or unknown, which it may now have, have ever had, or may in the future have against the Trust, the Company or the Representatives as it relates to this Agreement. 
 12. Miscellaneous. 
 12.1. Notices and all other communications
contemplated by this Agreement shall be in writing and shall be deemed to have been duly given (a) when personally delivered to the party to be notified, (b) one day following mailing via Federal Express or similar overnight courier
service to the address of the party specified in this Agreement or otherwise specified in writing, specifying next day delivery, with written verification of receipt, (c) five (5) days after having been sent by registered or certified
mail, return receipt requested, postage replied, or (d) upon sending, if sent by confirmed electronic mail (with delivery receipt requested) or facsimile during normal business hours of the recipient; if sent by such means but not during such
hours, then on the next business day. 
 12.2. No provision of this Agreement shall be modified or amended unless the
modification or amendment is agreed to in writing and signed by the parties. No delay or omission to exercise any right, 

  
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power or remedy accruing to any party, upon any breach, default or noncompliance by another party under this Agreement will impair any such right, power or remedy of such non-defaulting party,
nor shall it be construed to be a waiver of any such breach, default or noncompliance, or any acquiescence therein, or of or in any similar breach, default or noncompliance thereafter occurring nor shall any waiver of any single breach or default be
deemed a waiver of any other breach or default theretofore or thereafter occurring. 
 12.3. This Agreement, together with the
Trust Documents (which shall remain in full force and effect to the extent not expressly modified herein), constitutes the full and entire understanding and agreement between and among the parties with regard to the subject hereof and supersedes all
prior arrangements and understandings regarding the same, and no party shall be liable for or bound to any other in any manner by any oral or written representations, warranties, covenants, agreements or understandings except as specifically set
forth herein and therein. 
 12.4. Except as expressly otherwise provided in this Agreement, the validity, interpretation,
construction and performance of this Agreement shall be governed by the laws of the State of Delaware in all respects, regardless of choice of law provisions. 
 12.5. The invalidity, illegality or unenforceability, for any reason, of any provision or provisions of this Agreement shall not affect the validity or enforceability of any other provision hereof, which
shall remain in full force and effect and be construed as if such invalid, illegal or unenforceable provision had never been contained herein. 
 12.6. Construction. The headings and captions of this Agreement are provided for convenience only and are intended to have no effect in construing or interpreting this Agreement. The language in all parts
of this Agreement shall be in all cases construed according to its fair meaning and not strictly for or against the parties. 

12.7. If any legal action or proceeding is brought for the enforcement of this Agreement or because of an alleged dispute, breach,
default or misrepresentation in connection with any provisions of this Agreement, the prevailing party or parties shall be entitled to recover reasonable attorneys’ fees and other reasonable costs incurred in that action or proceeding,
including any appeals, in addition to any other relief to which it or they may be entitled. 
 12.8. This Agreement may be
executed in counterparts, each of which shall be deemed an original, but all of which together will constitute one and the same instrument. Execution of a facsimile or PDF copy shall have the same force and effect as execution of an original.

 12.9. Any conflict, claim, or dispute between the parties arising under or related in any way to this Agreement, or any
breach of this Agreement, or any claim that any of this Agreement is invalid, illegal, voidable, or void, or any other claim relating to either party’s performance or non-performance of this Agreement, shall be subject to mandatory, binding
arbitration under the authority of the American Arbitration Association. The arbitration shall be conducted before a panel of three arbitrators using the Commercial Arbitration Rules. The location of the arbitration shall be in San Francisco,
California. The 

  
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arbitrators’ award may be entered in any court with jurisdiction. At the request of either party prior to the arbitration award, the arbitrators shall make written findings of fact and
conclusions of law as part of their award. Each party shall pay all applicable fees and costs billed by the American Arbitration Association prior to arbitration, including without limitation the arbitrators’ fees and expenses. 

12.10. The Investor may not assign this Agreement or its rights hereunder, or delegate its obligations hereunder, without the prior
written consent of each of the Trust and the Company. 
 12.11. Any party may terminate this Agreement at any time by providing
written notice of termination to the other parties at least thirty (30) days prior to the effective date of such termination. And party shall have the right to terminate this Agreement immediately upon written notice to the other Parties in any
of the following circumstances: 
 (a) any representation or warranty made by any other party in this Agreement shall be
incorrect in any material respect and shall not have been corrected within twenty (20) days after written notice thereof has been given to the other parties; 
 (b) any other party shall default in the performance of any obligation or undertaking under this Agreement and such default shall continue for twenty (20) days after written notice thereof has been
given to the other parties; 
 (c) The Trust or the Company receive written notice from Millennium or the Investor that the
Investor has closed or intends to close the Custodial Account, unless the parties to this Agreement have previously consented to the closing of such Custodial Account in writing; 

(d) The Trust or the Company become aware of any material breach of any other agreement to which Investor is a party (including any
representation or warranty therein) relating to the Certificate or Account, including but not limited to the Series Supplement, the Company’s Terms of Use and any agreement between the Company and Investor governing Investor’s use of the
API, if applicable; or 
 (e) if any other party shall commence a voluntary case or other proceeding seeking liquidation,
reorganization, or other relief with respect to itself or its debts under any bankruptcy, insolvency, receivership, conservatorship or other similar law now or hereafter in effect or seeking the appointment of a trustee, receiver, liquidator,
conservator, custodian, or other similar official of it or any substantial part of its property, or shall consent to any such relief or to the appointment of a trustee, receiver, liquidator, conservator, custodian, or other similar official or to
any involuntary case or other similar proceeding commenced against it, or shall make a general assignment for the benefit of creditors, or shall fail generally to pay its debts as they become due, or shall take any corporate action to authorize any
of the foregoing. 
 [Signature Page Follows] 

  
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 IN WITNESS WHEREOF, the undersigned parties have caused this Agreement to be executed as of the day and year
first above written. 
  

			
	LC TRUST I
		
	By:	 	  

		
	Name:	 	  

		
	Title:	 	  

	
	LENDINGCLUB CORPORATION
		
	By:	 	  

		
	Name:	 	  

		
	Title:	 	  

	
	  

	Investor
		
	By:	 	  

		
	Name:	 	  

		
	Title:	 	  

  
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 APPENDIX A – CERTIFICATE PURCHASER INFORMATION FORM 

Please complete and sign this form and return it to LC Trust along with a signed W-9 or other appropriate tax form. Please note that in
some cases additional documentation may be requested by Lending Club following receipt of this form from LC Trust. 
 A. Contact
Information 
  

			
	Purchaser/Entity Purchaser Name:	 	  

		
	Permanent Address (no P.O. Boxes):	 	  

	(Individuals: Use Home Address)	 	
	(Entities: Primary Place of Business)	 	  

		
	Contact Address:	 	  

	(If Different)	 	
		 	  

 

			
	State of Incorporation/Organization and year Incorporated/Organized (Entities only):	 	  

 

			
	Name/Title of Primary Contact (Entities only):	 	  

 

			
	Name/Title of Principal, if Different (Entities only):	 	  

  

									
	Phone:	 	  
	 		 	Contact email:	 	  

					
	SSN/Tax ID:	 	  
	 		 	Date of Birth (Individuals):	 	  

 

			
	Driver’s License No./Issuing State (Individuals)(please attach photocopy):	 	  

 

							
	Trustee or Plan Sponsor Name/Address (required if Purchaser is a trust or benefit plan):	 		 		 	  

	
	  

 B. Type of Purchaser Select one. 

 

													
	 ̈	 	Individual	 	 ̈	 	Tenants in Common	 	 ̈	 	Limited Liability Partnership
						
	 ̈	 	Community Property	 	 ̈	 	Partnership	 	 ̈	 	Limited Liability Company
						
	 ̈	 	Estate	 	 ̈	 	C Corporation	 	 ̈	 	Other:
                                         
                           
						
	 ̈	 	Exempt Organization	 	 ̈	 	S Corporation	 	 ̈	 	A trust (check applicable box below):
							
	 ̈	 	IRA / Keogh / SEP	 	 ̈	 	Limited Partnership	 		 	 ̈	 	An irrevocable trust
							
	 ̈	 	Joint Tenant	 	 ̈	 	General Partnership	 		 	 ̈	 	Living/revocable trust (specify # of grantor(s):     )

 C. Accredited Investor Status Select one or more, as applicable. See following page for
additional categories. 
 The Purchaser makes one of the following representations regarding the Purchaser’s status as an
“accredited investor” (within the meaning of Rule 501 under the Securities Act) as follows. The Purchaser is: 
  

			
	 ̈	  	A natural person whose individual net worth, or joint net worth with his or her spouse, exceeds $1,000,000.1
		
	 ̈	  	 A natural person who had an individual income in excess of $200,000 in each of the two most recent years or a joint income with
his or her spouse in excess of $300,000 in each of those years, and has a reasonable expectation of reaching the same income level in the current year.

  

	1 	 For purposes of calculating “net worth,” the value of the Purchaser’s primary residence must be excluded. Any related indebtedness
secured by such residence up to its fair market value may be excluded. Indebtedness secured by such residence in excess of its fair market value should be deducted from the Purchaser’s net worth. 

					
	 ̈	  	 An organization described in Section 501(c)(3) of the Internal Revenue Code, not formed for the specific purpose
of acquiring the Certificate, with total assets in excess of $5,000,000.

		
	 ̈	  	 A corporation, not formed for the specific purpose of acquiring the Certificate, with total assets in excess of
$5,000,000.

		
	 ̈	  	 A partnership, not formed for the specific purpose of acquiring the Certificate, with total assets in excess of
$5,000,000.

		
	 ̈	  	 A limited liability company, not formed for the specific purpose of acquiring the Certificate, with total assets in
excess of $5,000,000.

		
	 ̈	  	 A Massachusetts or similar business trust, not formed for the specific purpose of acquiring the Certificate, with
total assets in excess of $5,000,000.

		
	 ̈	  	 A trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the Certificate,
whose purchase is directed by a person with such knowledge and experience in financial and business matters that such person is capable of evaluating the merits and risks of an investment in a Certificate.

		
	 ̈	  	 An entity in which all of the equity owners are accredited investors. (In the case of a Purchaser that is a revocable
trust, all of the grantors and trustees are accredited investors. Please note that irrevocable trusts are not eligible for this category and must choose another representation.) If the Purchaser belongs to this category only, please list on a
separate sheet to be attached hereto the equity owners (or grantors and trustees) of the Purchaser and the category which each such equity owner (or grantor and trustee) satisfies.

		
	 ̈	  	 A bank as defined in Section 3(a)(2) of the Securities Act.

		
	 ̈	  	 A savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities
Act.

		
	 ̈	  	 An SEC-registered broker-dealer.

		
	 ̈	  	 An insurance company as defined in Section 2(13) of the Securities Act.

		
	 ̈	  	 An SEC-registered investment company or a “business development company” as defined in the Investment
Company Act of 1940.

		
	 ̈	  	A Small Business Investment Company licensed by the U.S. Small Business Administration.
		
	 ̈	  	 A plan established and maintained by a state or its political subdivisions, or any agency or instrumentality thereof,
for the benefit of its employees, if such plan has total assets in excess of $5,000,000.

		
	 ̈	  	 An employee benefit plan within the meaning of ERISA. The Purchaser further represents that:

			
		  	 ̈	  	the investment decision is made by a plan fiduciary which is either a bank, savings and loan association, insurance company, or registered investment adviser;
			
		  	 ̈	  	the employee benefit plan has total assets of $5,000,000; or
			
		  	 ̈	  	the plan is self-directed and investment decisions are made solely by accredited investors.
		
	 ̈	  	A private business development company as defined in the Investment Advisers Act of 1940.
		
	 ̈	  	The Purchaser is not an accredited investor. (The Purchaser or the Purchaser’s counsel should contact Tangela Richter (immediately.)

 SIGN AND DATE BELOW 

 

					
	Purchaser:	 		 	
			
	  
	 		 	  

	By:	 		 	Date
	Title:	 		 	
			
	Joint Purchaser/Co-Trustee/Co-Signer, if required:	 		 	
			
	  
	 		 	  

	By:	 		 	Date
	Title:EX-4.2

 Exhibit 4.2 

DOMINION GAS HOLDINGS, LLC 
 Issuer

 AND 
 DEUTSCHE BANK TRUST
COMPANY AMERICAS 
 Trustee 
  

 
 Fourth
Supplemental Indenture 
 Dated as of December 1, 2014 

 
  

$450,000,000 
 2014 Series A 2.50%
Senior Notes 
 due 2019 

 TABLE OF CONTENTS* 

 

							
	 ARTICLE I        2014 SERIES A 2.50% SENIOR NOTES DUE 2019
	  	 	1	  
	 Section 101.
	 	Establishment	  	 	1	  
	 Section 102.
	 	Definitions	  	 	2	  
	 Section 103.
	 	Payment of Principal and Interest	  	 	4	  
	 Section 104.
	 	Denominations	  	 	5	  
	 Section 105.
	 	Global Securities	  	 	5	  
	 Section 106.
	 	Redemption	  	 	6	  
	 Section 107.
	 	Sinking Fund	  	 	7	  
	 Section 108.
	 	Additional Interest	  	 	7	  
	 Section 109.
	 	Paying Agent	  	 	7	  
	 ARTICLE II        MISCELLANEOUS PROVISIONS
	  	 	7	  
	 Section 201.
	 	Ratification and Incorporation of Base Indenture	  	 	7	  
	 Section 202.
	 	Executed in Counterparts	  	 	7	  
	 Section 203.
	 	Assignment	  	 	7	  
	 Section 204.
	 	Trustee’s Disclaimer	  	 	7	  

  

	* 	This Table of Contents does not constitute part of the Indenture or have any bearing upon the interpretation of any of its terms and provisions. 

 THIS FOURTH SUPPLEMENTAL INDENTURE is made as of the 1st day of December, 2014, by and between
DOMINION GAS HOLDINGS, LLC, a Virginia limited liability company, having its principal office at 120 Tredegar Street, Richmond, Virginia 23219 (the “Company”), and DEUTSCHE BANK TRUST COMPANY AMERICAS, a New York banking corporation,
as Trustee, having a corporate trust office at 60 Wall Street, 16th Floor, New York, New York 10005 (herein called the “Trustee”). 

W I T N E S S E T H: 
 WHEREAS,
the Company has heretofore entered into an Indenture dated as of October 1, 2013, between the Company and the Trustee (as amended, restated or otherwise modified, the “Base Indenture”) with respect to senior debt securities; 

WHEREAS, the Base Indenture is incorporated herein by this reference and the Base Indenture, as heretofore supplemented, as further
supplemented by this Fourth Supplemental Indenture, and as may be hereafter supplemented or amended from time to time, is herein called the “Indenture”; 

WHEREAS, under the Base Indenture, a new series of Securities may at any time be established in accordance with the provisions of the Base
Indenture and the terms of such series may be described by a supplemental indenture executed by the Company and the Trustee; 
 WHEREAS, the
Company proposes to create under the Indenture a new series of Securities; 
 WHEREAS, additional Securities of other series hereafter
established, except as may be limited in the Base Indenture as at the time supplemented and modified, may be issued from time to time pursuant to the Indenture as at the time supplemented and modified; 

WHEREAS, all conditions necessary to authorize the execution and delivery of this Fourth Supplemental Indenture and to make it a valid and
binding obligation of the Company have been done or performed. 
 NOW, THEREFORE, in consideration of the agreements and obligations set
forth herein and for other good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties hereto hereby agree as follows: 

ARTICLE I 
 2014 SERIES A
2.50% SENIOR NOTES DUE 2019 
 Section 101.    Establishment. There is hereby established a new series of
Securities to be issued under the Indenture, to be designated as the Company’s 2014 Series A 2.50% Senior Notes due 2019 (the “Series A Senior Notes”). 

 There are to be authenticated and delivered $450,000,000 principal amount of Series A Senior
Notes, and such principal amount of the Series A Senior Notes may be increased from time to time pursuant to the penultimate paragraph of Section 301 of the Base Indenture. All Series A Senior Notes need not be issued at the same time
and such series may be reopened at any time, without the consent of any Holder, for issuances of additional Series A Senior Notes. Any such additional Series A Senior Notes will have the same interest rate, maturity and other terms as
those initially issued. Further Series A Senior Notes may also be authenticated and delivered as provided by Sections 304, 305, 306, 905 or 1107 of the Base Indenture. 

The Series A Senior Notes shall be issued as Registered Securities in global form without coupons, in substantially the form set out in
Exhibit A hereto. The entire initially issued principal amount of the Series A Senior Notes shall initially be evidenced by one or more certificates issued to Cede & Co., as nominee for The Depository Trust Company. 

The form of the Trustee’s Certificate of Authentication for the Series A Senior Notes shall be in substantially the form set forth
in Exhibit B hereto. 
 Each Series A Senior Note shall be dated the date of authentication thereof and shall bear interest
from the date of original issuance thereof or from the most recent Interest Payment Date to which interest has been paid or duly provided for. 

Section 102.    Definitions. The following defined terms used herein shall, unless the context otherwise requires,
have the meanings specified below. Capitalized terms used herein for which no definition is provided herein shall have the meanings set forth in the Base Indenture. Unless the context otherwise requires, any reference to a “Section” refers
to a Section of this Fourth Supplemental Indenture. 
 “Business Day” means a day other than (i) a Saturday or a Sunday,
(ii) a day on which banks in New York, New York are authorized or obligated by law or executive order to remain closed or (iii) a day on which the Corporate Trust Office is closed for business. 

“Comparable Treasury Issue” means the United States Treasury security selected by an Independent Investment Banker as having a
maturity comparable to the remaining term of the Series A Senior Notes to be redeemed (assuming, for this purpose, that the Series A Senior Notes matured on November 15, 2019) that would be utilized, at the time of selection and in
accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable maturity to the remaining term in years and months of the Series A Senior Notes. 

“Comparable Treasury Price” for any Redemption Date means (i) the average of the Reference Treasury Dealer Quotations for such
Redemption Date, after excluding the highest and lowest Reference Treasury Dealer Quotations, or (ii) if the Independent Investment Banker obtains fewer than five such Reference Treasury Dealer Quotations, the average of all such quotations.

 “Independent Investment Banker” means any of Goldman, Sachs & Co., RBS Securities Inc., BNP Paribas Securities Corp.
and Scotia Capital (USA) Inc., and their respective affiliates or successors, as selected by the Company, or if any such firm is unwilling or unable to serve as such, an independent investment and banking institution of national standing appointed
by the Company. 

  
 2 

 “Interest Payment Dates” means June 15 and December 15 of each year,
commencing on June 15, 2015. 
 “Original Issue Date” means December 8, 2014. 

“Outstanding,” when used with respect to the Series A Senior Notes, means, as of the date of determination, all Series A
Senior Notes theretofore authenticated and delivered under the Indenture, except: 
 (i)    Series A Senior Notes
theretofore canceled by the Trustee or delivered to the Trustee for cancellation; 
 (ii)    Series A Senior Notes
for whose payment at the Maturity thereof money in the necessary amount has been theretofore deposited (other than pursuant to Section 402 of the Base Indenture) with the Trustee or any Paying Agent (other than the Company) in trust or set
aside and segregated in trust by the Company (if the Company shall act as its own Paying Agent) for the Holders of such Series A Senior Notes, provided that, if such Series A Senior Notes are to be redeemed, notice of such redemption has
been duly given pursuant to this Indenture or provision therefor satisfactory to the Trustee has been made; 

(iii)    Series A Senior Notes with respect to which the Company has effected defeasance or covenant defeasance
pursuant to Section 402 of the Base Indenture, except to the extent provided in Section 402 of the Base Indenture; and 

(iv)    Series A Senior Notes that have been paid pursuant to Section 306 of the Base Indenture or in exchange
for or in lieu of which other Series A Senior Notes have been authenticated and delivered pursuant to the Indenture, other than any such Series A Senior Notes in respect of which there shall have been presented to the Trustee proof
satisfactory to it that such Series A Senior Notes are held by a bona fide purchaser in whose hands such Series A Senior Notes are valid obligations of the Company; 

provided, however, that in determining whether the Holders of the requisite principal amount of Outstanding Series A Senior Notes have given any request,
demand, authorization, direction, notice, consent or waiver under the Indenture or are present at a meeting of Holders of Series A Senior Notes for quorum purposes, Series A Senior Notes owned by the Company or any other obligor upon the
Series A Senior Notes or any Affiliate of the Company or such other obligor shall be disregarded and deemed not to be Outstanding, except that, in determining whether the Trustee shall be protected in making any such determination or relying
upon any such request, demand, authorization, direction, notice, consent or waiver, only Series A Senior Notes which a Responsible Officer of the Trustee actually knows to be so owned shall be so disregarded. Series A Senior Notes so owned
which shall have been pledged in good faith may be regarded as Outstanding if the pledgee establishes to the satisfaction of the Trustee (A) the pledgee’s right so to act with respect to such Series A Senior Notes and (B) that
the pledgee is not the Company or any other obligor upon the Series A Senior Notes or an Affiliate of the Company or such other obligor. 

“Primary Treasury Dealer” means a primary United States government securities dealer in the United States as designated by the
Federal Reserve Bank of New York. 

  
 3 

 “Reference Treasury Dealer” means Goldman, Sachs & Co., RBS Securities
Inc., BNP Paribas Securities Corp. and Scotia Capital (USA) Inc., and their respective affiliates or successors; provided that, if any such firm or its successors ceases to be a Primary Treasury Dealer, the Company shall substitute another
Primary Treasury Dealer. 
 “Reference Treasury Dealer Quotations” means, with respect to each Reference Treasury Dealer and any
Redemption Date, the average, as determined by the Independent Investment Banker, of the bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted in writing to the Independent
Investment Banker at 3:30 p.m., New York City time, on the third Business Day preceding such Redemption Date. 
 “Regular Record
Date” means, with respect to each Interest Payment Date, the close of business on the Business Day preceding such Interest Payment Date; provided, that with respect to Series A Senior Notes that are not represented by one or more Global
Securities, the Regular Record Date shall be the close of business on the 15th calendar day (whether or not a Business Day) preceding such Interest Payment Date. 

“Securities Act” means the Securities Act of 1933, as amended. 

“Stated Maturity” means December 15, 2019. 

“Treasury Rate” means, with respect to any Redemption Date, the rate per annum equal to the semiannual equivalent yield to maturity
or interpolated (on a day count basis) of the Comparable Treasury Issue, assuming a price for the Comparable Treasury Issue (expressed as a percentage of its principal amount) equal to the Comparable Treasury Price for such Redemption Date. 

The terms “Company,” “Trustee,” “Base Indenture,” and “Indenture” shall have the respective meanings
set forth in the recitals to this Fourth Supplemental Indenture and the paragraph preceding such recitals. 
 Section
103.    Payment of Principal and Interest. The principal of the Series A Senior Notes shall be due at the Stated Maturity (unless earlier redeemed). The unpaid principal amount of the Series A Senior Notes shall
bear interest at the rate of 2.50% per annum until paid or duly provided for, such interest to accrue from the Original Issue Date or from the most recent Interest Payment Date to which interest has been paid or duly provided for. Interest shall be
paid semi-annually in arrears on each Interest Payment Date to the Person in whose name the Series A Senior Notes are registered on the Regular Record Date for such Interest Payment Date; provided that interest payable at the Stated Maturity of
principal or on a Redemption Date as provided herein will be paid to the Person to whom principal is payable. Any such interest that is not so punctually paid or duly provided for will forthwith cease to be payable to the Holders on such Regular
Record Date and may either be paid to the Person or Persons in whose name the Series A Senior Notes are registered at the close of business on a Special Record Date for the payment of such defaulted interest to be fixed by the 

Trustee (in accordance with Section 307 of the Base Indenture), notice whereof shall be given to Holders of the Series A Senior Notes not less than
ten (10) days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange, if any, on which the Series A Senior Notes may be listed, and upon such
notice as may be required by any such exchange, all as more fully provided in the Base Indenture. 

  
 4 

 Payments of interest on the Series A Senior Notes will include interest accrued to but
excluding the respective Interest Payment Dates. Interest payments for the Series A Senior Notes shall be computed and paid on the basis of a 360-day year of twelve 30-day months. In the event that any date on which interest is payable on the
Series A Senior Notes is not a Business Day, then payment of the interest payable on such date will be made on the next succeeding day that is a Business Day (and without any interest or payment in respect of any such delay), in each case with
the same force and effect as if made on the date the payment was originally payable. 
 Payment of the principal and interest on the
Series A Senior Notes shall be made at the office of the Paying Agent 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, with any such payment that is due
at the Stated Maturity of any Series A Senior Notes, upon redemption or repurchase being made upon surrender of such Series A Senior Notes to the Paying Agent. Payments of interest (including interest on any Interest Payment Date) will be
made, subject to such surrender where applicable, at the option of the Company, (i) by check mailed to the address of the Person entitled thereto as such address shall appear in the Security Register or (ii) by wire transfer at such place
and to such account at a banking institution in the United States as may be designated in writing to the Trustee at least sixteen (16) days prior to the date for payment by the Person entitled thereto. In the event that any date on which
principal and interest is payable on the Series A Senior Notes is not a Business Day, then payment of the principal and interest payable on such date will be made on the next succeeding day that is a Business Day (and without any interest or
payment in respect of any such delay), in each case with the same force and effect as if made on the date the payment was originally payable. 

Section 104.    Denominations. The Series A Senior Notes may be issued in denominations of $1,000, or any
greater integral multiple of $1,000. 
 Section 105.    Global Securities. The Series A Senior Notes will be
initially issued in the form of one or more Global Securities registered in the name of the Depositary (which shall be The Depository Trust Company) or its nominee. Except under the limited circumstances described below, Series A Senior Notes
represented by such Global Securities will not be exchangeable for, and will not otherwise be issuable as, Series A Senior Notes in definitive form registered in names other than the Depositary or its nominee. The Global Securities described
above may not be transferred except by the Depositary to a nominee of the Depositary or by a nominee of the Depositary to the Depositary or another nominee of the Depositary or to a successor Depositary or its nominee. 

Owners of beneficial interests in such a Global Security will not be considered the Holders thereof for any purpose under the Indenture, and
no Global Security representing a Series A Senior Note shall be exchangeable, except for another Global Security of like denomination and tenor to be registered in the name of the Depositary or its nominee or to a successor Depositary or its
nominee or except as described below. The rights of Holders of such Global Security shall be exercised only through the Depositary. 

  
 5 

 A Global Security shall be exchangeable for Series A Senior Notes registered in the names of
persons other than the Depositary or its nominee only if (i) the Depositary notifies the Company that it is unwilling or unable to continue as a Depositary for such Global Security and no successor Depositary shall have been appointed by the
Company within 90 days of receipt by the Company of such notification, or if at any time the Depositary ceases to be a clearing agency registered under the Exchange Act at a time when the Depositary is required to be so registered to act as
such Depositary and no successor Depositary shall have been appointed by the Company within 90 days after it becomes aware of such cessation, (ii) the Company in its sole discretion, and subject to the procedures of the Depositary,
determines that such Global Security shall be so exchangeable, in which case Series A Senior Notes in definitive form will be printed and delivered to the Depositary, or (iii) an Event of Default has occurred and is continuing with respect
to the Series A Senior Notes. Any Global Security that is exchangeable pursuant to the preceding sentence shall be exchangeable for Series A Senior Notes registered in such names as the Depositary shall direct. 

Section 106.    Redemption. Prior to November 15, 2019, the Series A Senior Notes are redeemable, in
whole or in part at any time and from time to time at the option of the Company, at a Redemption Price equal to the greater of: 
 (i)
    100% of the principal amount of Series A Senior Notes then Outstanding to be so redeemed, or 

(ii)    the sum of the present values of the remaining scheduled payments of principal and interest on the Series A
Senior Notes to be redeemed that would be due if such Series A Senior Notes matured on November 15, 2019 but for the redemption (not including any portion of such payments of interest accrued as of the Redemption Date) discounted to the
Redemption Date on a semi-annual basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate, plus 15 basis points, as calculated by an Independent Investment Banker, 

plus, in either of the above cases, accrued and unpaid interest thereon to the Redemption Date. On or after November 15, 2019, the Series A Senior
Notes are redeemable, in whole or in part, at any time and from time to time at the option of the Company, at a Redemption Price equal to 100% of the principal amount of Series A Senior Notes then Outstanding to be so redeemed, plus accrued and
unpaid interest thereon to the Redemption Date. 
 The Treasury Rate shall be calculated no later than the third Business Day preceding the
Redemption Date. 
 Unless the Company defaults in the payment of the Redemption Price, on and after the Redemption Date, interest will
cease to accrue on the Series A Senior Notes or portions thereof called for redemption. 
 In the event of the redemption of the
Series A Senior Notes in part only, a new Series A Senior Note or Notes for the unredeemed portion will be issued in the name or names of the Holders thereof upon surrender thereof. 

  
 6 

 The Company shall notify the Trustee of the Redemption Price in writing promptly after the
calculation thereof and the Trustee shall have no responsibility for such calculation. The notice of redemption shall be sent in accordance with the terms of the Base Indenture. 

Section 107.    Sinking Fund. The Series A Senior Notes shall not have a sinking fund. 

Section 108.    Additional Interest on Overdue Amounts. Any principal of and installment of interest on the
Series A Senior Notes that is overdue shall bear interest at the rate of 2.50% (to the extent that the payment of such interest shall be legally enforceable), from the dates such amounts are due until they are paid or made available for
payment, and such interest shall be payable on demand. 
 Section 109.    Paying Agent. The Trustee shall
initially serve as Paying Agent with respect to the Series A Senior Notes, with the Place of Payment initially being the Corporate Trust Office. 

ARTICLE II 

MISCELLANEOUS PROVISIONS 

Section 201.    Ratification and Incorporation of Base Indenture. As supplemented hereby, the Base Indenture is in
all respects ratified and confirmed by the Company, and the Base Indenture and this Fourth Supplemental Indenture shall be read, taken and construed as one and the same instrument. 

Section 202.    Executed in Counterparts. This Fourth Supplemental Indenture may be executed in several
counterparts, each of which shall be deemed to be an original, and such counterparts shall together constitute but one and the same instrument. The exchange of copies of this Fourth Supplemental Indenture and of signature pages by facsimile or PDF
transmission shall constitute effective execution and delivery of this Fourth Supplemental Indenture as to the parties hereto and may be used in lieu of the original manually executed Fourth Supplemental Indenture for all purposes. Signatures of the
parties hereto transmitted by facsimile or PDF shall be deemed to be their original signatures for all purposes. 
 Section
203.    Assignment. The Company shall have the right at all times to assign any of its rights or obligations under the Indenture with respect to the Series A Senior Notes to a direct or indirect wholly-owned subsidiary of the Company; provided that, in the event of any such assignment, the Company shall remain primarily liable for the performance of all such obligations. The Indenture may also be assigned
by the Company in connection with a transaction described in Article Eight of the Base Indenture. 
 Section
204.    Trustee’s Disclaimer. All of the provisions contained in the Base Indenture in respect of the rights, powers, privileges, protections, duties and immunities of the Trustee, including without limitation its
right to be indemnified, shall be applicable in respect of the Series A Senior Notes and of this Fourth Supplemental Indenture as fully and with like effect as if set forth herein in full. The Trustee accepts the amendments of the Indenture
effected by this Fourth Supplemental Indenture, but on the terms and conditions set forth in the Indenture, including the terms and provisions defining and limiting the liabilities and responsibilities of the

  
 7 

 
Trustee. Without limiting the generality of the foregoing, the Trustee shall not be responsible in any manner whatsoever for or with respect to any of the recitals or statements contained herein,
all of which recitals or statements are made solely by the Company, or for or with respect to (i) the validity or sufficiency of this Fourth Supplemental Indenture or any of the terms or provision hereof, (ii) the proper authorization
hereof by the Company by action or otherwise, (iii) the due execution hereof by the Company, or (iv) the consequences of any amendment herein provided for, and the Trustee makes no representation with respect to any such matters. 

[Signature Page Follows] 

  
 8 

 IN WITNESS WHEREOF, each party hereto has caused this instrument to be signed in its name and
behalf by its duly authorized officer, all as of the day and year first above written. 
  

			
	DOMINION GAS HOLDINGS, LLC
		
	By:	 	/s/ G. Scott Hetzer
	Name:	 	G. Scott Hetzer
	Title:	 	Senior Vice President and Treasurer
	
	DEUTSCHE BANK TRUST COMPANY AMERICAS, as Trustee
		
	By:	 	/s/ Carol Ng
	Name:	 	Carol Ng
	Title:	 	Vice President
		
	By:	 	/s/ Anthony D’ Amato
	Name:	 	Anthony D’ Amato
	Title:	 	Associate

  
 9 

 EXHIBIT A 

FORM OF 
 2014
SERIES A 2.50% SENIOR NOTE 
 DUE 2019 

[UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY (55 WATER STREET, NEW YORK, NEW
YORK) TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF [CEDE & CO.] OR SUCH OTHER NAME AS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST
COMPANY AND ANY PAYMENT IS MADE TO [CEDE & CO.], ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL SINCE THE REGISTERED OWNER HEREOF, [CEDE & CO.], HAS AN INTEREST HEREIN.]** 
 [THIS SERIES A SENIOR NOTE 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 SERIES A SENIOR NOTE MAY NOT BE EXCHANGED IN WHOLE OR IN PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SERIES A SENIOR
NOTE 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. EVERY SERIES A SENIOR NOTE AUTHENTICATED AND DELIVERED UPON
REGISTRATION OF, TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SERIES A SENIOR NOTE SHALL BE A GLOBAL SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.]** 

 
  

DOMINION GAS HOLDINGS, LLC 
  

 

$             

2014 SERIES A 2.50% SENIOR NOTE 

DUE 2019 
  

			
	No. R-	 	CUSIP No. 257375AG0

 Dominion Gas Holdings, LLC, a limited liability company duly organized and existing under the laws of Virginia
(herein called the “Company,” which term includes any successor Person under the Indenture hereinafter referred to), for value received, hereby promises to pay to [Cede & Co.]**, or registered assigns (the “Holder”), the
principal sum of              Dollars ($            ) on December 15, 2019 and to pay interest thereon from December 8,
2014 or from the most recent Interest Payment Date to which interest has been paid or duly 
  

 

	** 	Insert in Global Securities. 

  
 10 

 
provided for, semi-annually in arrears on June 15 and December 15 of each year, commencing on June 15, 2015 at the rate of 2.50% per annum, until the principal hereof is paid
or made available for payment, provided that any principal, and any such installment of interest, that is overdue shall bear interest at the rate of 2.50% per annum (to the extent that the payment of such interest shall be legally enforceable),
from the dates such amounts are due until they are paid or made available for payment, and such interest shall be payable on demand. The interest so payable, and punctually paid or duly provided for, on any Interest Payment Date will, as provided in
such Indenture, be paid to the Person in whose name this Series A Senior Note (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest; provided that the interest payable at
Stated Maturity or on a Redemption Date will be paid to the Person to whom principal is payable. The Regular Record Date shall be the close of business on the Business Day preceding such Interest Payment Date; provided, that with respect to
Series A Senior Notes that are not represented by one or more Global Securities, the Regular Record Date shall be the close of business on the 15th calendar day (whether or not a Business Day) preceding such Interest Payment Date. Any such
interest not so punctually paid or duly provided for will forthwith cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Series A Senior Note (or one or more Predecessor
Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof shall be given to Holders of Series A Senior Notes not less than 10 days
prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange on which the Series A Senior Notes may be listed, and upon such notice as may be required by
such exchange, all as more fully provided in said Indenture. 
 Payments of interest on the Series A Senior Notes will include interest
accrued to but excluding the respective Interest Payment Dates. Interest payments for the Series A Senior Notes shall be computed and paid on the basis of a 360-day year of twelve 30-day months. In the event that any date on which interest is
payable on the Series A Senior Notes is not a Business Day, then payment of the interest payable on such date will be made on the next succeeding day that is a Business Day (and without any interest or payment in respect of any such delay), in
each case with the same force and effect as if made on the date the payment was originally payable. 
 Payment of the principal of and
interest on this Series A Senior Note will be made at the office of the Paying Agent, in the Borough of Manhattan, City and State of New York, 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, with any such payment that is due at the Stated Maturity of any Series A Senior Note, upon redemption or repurchase being made upon surrender of such Series A Senior Note to such office or agency;
provided, however, that at the option of the Company payment of interest, subject to such surrender where applicable, may be made (i) by check mailed to the address of the Person entitled thereto as such address shall appear in the Security
Register or (ii) by wire transfer at such place and to such account at a banking institution in the United States as may be designated in writing to the Trustee at least sixteen (16) days prior to the date for payment by the Person
entitled thereto. 
 Reference is hereby made to the further provisions of this Series A Senior Note set forth on the reverse hereof,
which further provisions shall for all purposes have the same effect as if set forth at this place. 

  
 11 

 Unless the certificate of authentication hereon has been executed by the Trustee referred to on
the reverse hereof by manual signature, this Series A Senior Note shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 

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

 

							
	Dated:	 		 	DOMINION GAS HOLDINGS, LLC
				
		 		 	By:	 	 
				
		 		 	Name:	 	 
				
		 		 	Title:	 	 

  
 12 

 [REVERSE OF 2014 SERIES A 2.50% SENIOR NOTE] 

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 October 1, 2013 (the “Base Indenture”), as heretofore supplemented and as further supplemented by a Fourth Supplemental Indenture dated as of December 1, 2014 (the
“Fourth Supplemental Indenture” and together with the Base Indenture, as it may be hereafter supplemented or amended from time to time, the “Indenture,” which term shall have the meaning assigned to it in such instrument), by and
between the Company and Deutsche Bank Trust Company Americas, as Trustee (the “Trustee”), 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 and the Holders of the Securities and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is one of the series designated on the face hereof (the “Series A Senior
Notes”) which is unlimited in aggregate principal amount. 
 The Series A Senior Notes are redeemable, in whole or in part, at any
time and from time to time in the manner and with the effect provided in the Indenture. 
 If an Event of Default with respect to
Series A Senior Notes shall occur and be continuing, the principal of the Series A Senior Notes may be declared due and payable in the manner and with the effect provided in the Indenture. 

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 for the series of Securities affected, with the consent of the Holders of a majority in
principal amount of the Securities at the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of specified percentages in principal amount of the Securities of each series at the time
Outstanding, 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 Series A Senior Note shall be conclusive and
binding upon such Holder and upon all future Holders of this Series A Senior Note and of any Series A Senior Note issued upon the registration of transfer hereof or in exchange therefor or in lieu hereof, whether or not notation of such
consent or waiver is made upon this Series A Senior Note. 
 As provided in and subject to the provisions of the Indenture, the Holder
of this Series A Senior Note shall not have the right to institute any proceeding with respect to the Indenture or for the appointment of a receiver or trustee or for any other remedy thereunder, unless such Holder shall have previously given
the Trustee written notice of a continuing Event of Default with respect to the Series A Senior Notes, the Holders of not less than a majority in principal amount of the Series A Senior Notes at the time Outstanding shall have made written
request to the Trustee to institute proceedings in respect of such Event of Default as Trustee and offered the Trustee indemnity or security reasonably satisfactory to it, and the Trustee shall not have received from the Holders of a majority in
principal amount of Series A Senior Notes 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 Series A Senior Note for the enforcement of any payment of principal hereof or premium, if any, or interest hereon on or after the respective due dates expressed or
provided for herein. 

  
 13 

 No reference herein to the Indenture and no provision of this Series A Senior Note or of the
Indenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay the principal of, premium, if any, and interest on this Series A Senior Note at the times, place and rate, and in the coin or currency,
herein prescribed. 
 As provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Series A
Senior Note is registrable in the Security Register, upon surrender of this Series A Senior Note for registration of transfer at the office or agency of the Company in any place where the principal of, premium, if any, and interest on this
Series A Senior Note are payable, duly endorsed by, or accompanied by a written instrument of transfer in form satisfactory to the Company and the Security Registrar duly executed by, the Holder hereof or his attorney duly authorized in
writing, and thereupon one or more new Series A Senior Notes of like tenor, of authorized denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 

The Series A Senior Notes are issuable only in registered form without coupons in denominations of $1,000 and any greater integral
multiple of $1,000. As provided in the Indenture and subject to certain limitations therein set forth, Series A Senior Notes are exchangeable for a like aggregate principal amount of Series A Senior Notes having the same Stated Maturity
and of like tenor of any authorized denominations as requested by the Holder upon surrender of the Series A Senior Note or Series A Senior Notes to be exchanged at the office or agency of the Company. 

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 Series A Senior Note
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 Series A Senior Note be
overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 
 All terms used in this
Series A Senior Note that are defined in the Indenture shall have the meanings assigned to them in the Indenture. 

  
 14 

 ABBREVIATIONS 

The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they were written out in full according
to applicable laws or regulations: 
  

					
	TEN COM -	  	as tenants in common
		
	TEN ENT -	  	as tenants by the entireties
		
	JT TEN -	  	as joint tenants with rights of survivorship and not as tenants in common
			
	UNIF GIFT MIN ACT -	  	  
 (Cust)
	  	Custodian for
			
		  	  
 (Minor)
	  	
			
		  	Under Uniform Gifts to Minors Act of	  	
			
		  	  
 (State)
	  	
		
	Additional abbreviations may also be used though not on the above list.	  	
		
	  
	  	

  
 15 

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

					
		
	  
	 	.
	(please insert Social Security or other identifying number of assignee)	 	
		
	  
	 	.
		
	  
	 	.
		
	  
	 	.
		
	PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE OF ASSIGNEE	 	
		
	the within Series A Senior Note and all rights thereunder, hereby irrevocably constituting and appointing	 	
		
	  
	 	.
		
	  
	 	.
		
	  
	 	.
		  		 	
		
	  
	 	.
		
	  
	 	.
		
	  
	 	.
		
	agent to transfer said Series A Senior Note on the books of the Company, with full power of substitution in the premises.	 	
			
	Dated:
                                         
       ,                 	  		 	
			
		  	  
	 	
		
	NOTICE: The signature to this assignment must correspond with the name as written upon the face of the within instrument in every particular without alteration or enlargement, or any change whatever.	 	

  
 16 

 EXHIBIT B 

CERTIFICATE OF AUTHENTICATION 

This is one of the Securities of the series designated therein referred to in the within-mentioned
Indenture. 
  

			
	DEUTSCHE BANK TRUST COMPANY AMERICAS, as Trustee
		
	By:	 	 
		 	Authorized Signatory
	
	Dated:

  
 17

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