0001209191-21-004591.txt : 20210120
0001209191-21-004591.hdr.sgml : 20210120
20210120214414
ACCESSION NUMBER: 0001209191-21-004591
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210115
FILED AS OF DATE: 20210120
DATE AS OF CHANGE: 20210120
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rabois Keith
CENTRAL INDEX KEY: 0001539865
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 21540265
MAIL ADDRESS:
STREET 1: C/O YELP! INC.
STREET 2: 706 MISSION ST.
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94103
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Affirm Holdings, Inc.
CENTRAL INDEX KEY: 0001820953
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389]
IRS NUMBER: 842224323
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
BUSINESS PHONE: (415) 722-8633
MAIL ADDRESS:
STREET 1: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-01-15
0
0001820953
Affirm Holdings, Inc.
AFRM
0001539865
Rabois Keith
ONE LETTERMAN DRIVE
BUILDING D, 5TH FLOOR
SAN FRANCISCO
CA
94129
1
0
0
0
Class A Common Stock
2021-01-15
4
C
0
550000
0.00
A
1486909
I
By The Founders Fund Growth, LP
Class A Common Stock
2205293
I
By The Founders Fund VI, LP
Class A Common Stock
545294
I
By The Founders Fund VI Principals Fund, LP
Class A Common Stock
27418
I
By The Founders Fund VI Entrepreneurs Fund, LP
Class A Common Stock
60429
I
By The Founders Fund Growth Principals Fund, LP
Class A Common Stock
75000
I
By FF Affirm Growth, LLC
Class B Common Stock
2021-01-15
4
C
0
550000
D
Class A Common Stock
5500000
386909
I
By The Founders Fund Growth, LP
Class B Common Stock
Class A Common Stock
2205293
2205293
I
By The Founders Fund VI, LP
Class B Common Stock
Class A Common Stock
545294
545294
I
By The Founders Fund VI Principals Fund, LP
Class B Common Stock
Class A Common Stock
27418
27418
I
By The Founders Fund VI Entrepreneurs Fund, LP
Class B Common Stock
Class A Common Stock
60429
60429
I
By The Founders Fund Growth Principals Fund, LP
The Reporting Person has shared voting and investment power over the shares held by each of The Founders Fund VI, LP, The Founders Fund VI Principals Fund, LP, The Founders Fund VI Entrepreneurs Fund, LP, The Founders Fund Growth, LP, The Founders Fund Growth Principals Fund, LP and FF Affirm Growth, LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose.
Each share of the Issuer's Class B common stock, par value $0.00001 per share ("Class B Common Stock"), is convertible at any time into one share of the Issuer's Class A common stock, par value $0.00001 per share ("Class A Common Stock"). The Class B Common Stock has no expiration date.
/s/ Sharda Caro del Castillo as attorney-in-fact
2021-01-20