0001628280-21-019737.txt : 20211005
0001628280-21-019737.hdr.sgml : 20211005
20211005192152
ACCESSION NUMBER: 0001628280-21-019737
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211001
FILED AS OF DATE: 20211005
DATE AS OF CHANGE: 20211005
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Adkins Katherine
CENTRAL INDEX KEY: 0001870331
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 211308300
MAIL ADDRESS:
STREET 1: C/O AFFIRM HOLDINGS, INC.
STREET 2: 650 CALIFORNIA STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94108
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: 0630
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
wf-form4_163347609241328.xml
FORM 4
X0306
4
2021-10-01
0
0001820953
Affirm Holdings, Inc.
AFRM
0001870331
Adkins Katherine
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO
CA
94108
0
1
0
0
Chief Legal Officer
Class A Common Stock
2021-10-01
4
M
0
2491
0
A
10393
D
Class A Common Stock
2021-10-01
4
F
0
1129
117.85
D
9264
D
Restricted Stock Units
2021-10-01
4
M
0
2325
0
D
2027-10-26
Class A Common Stock
2325.0
23250
D
Restricted Stock Units
2021-10-01
4
M
0
166
0
D
Class A Common Stock
166.0
7284
D
Each Restricted Stock Unit (RSUs) represents a contingent right to receive one share of the Issuer's Class A Common Stock.
Represents the number of shares of the Issuer's Common Stock withheld to satisfy the Reporting Person's tax obligation in connection with the settlement of shares of Common Stock underlying the Reporting Person's RSUs that vested on October 1, 2021.
The total number of shares of Class A common stock has been adjusted to correct for a prior administrative error with respect to the number of shares of Class A common stock reported to be held by the Reporting Person.
The RSUs vest in 24 equal monthly installments until August 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date.
The total number of RSUs has been adjusted to correct for a prior administrative error with respect to the number of RSUs reported to be held by the Reporting Person.
The RSUs vest in 48 equal monthly installments after June 1, 2021, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date.
/s/ David Ritenour, Attorney-in-Fact
2021-10-05