0001628280-21-022616.txt : 20211109
0001628280-21-022616.hdr.sgml : 20211109
20211109180118
ACCESSION NUMBER: 0001628280-21-022616
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211108
FILED AS OF DATE: 20211109
DATE AS OF CHANGE: 20211109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jiyane Siphelele
CENTRAL INDEX KEY: 0001832806
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 211393587
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_163649885433327.xml
FORM 4
X0306
4
2021-11-08
0
0001820953
Affirm Holdings, Inc.
AFRM
0001832806
Jiyane Siphelele
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO
CA
94108
0
1
0
0
Vice President, Controller
Class A Common Stock
2021-11-08
4
M
0
4106
2.04
A
6974
D
Class A Common Stock
2021-11-08
4
S
0
4106
175
D
2868
D
Stock Option (Right to Buy)
2.04
2021-11-08
4
M
0
4106
0
D
2027-05-29
Class A Common Stock
4106.0
0
D
The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on September 15, 2021.
Stock option vests with respect to 1/24 of the shares of the Issuer's Class A common stock, par value $0.00001 per share ("Class A Common Stock"), underlying the stock option on the one-year anniversary of July 5, 2016, the vesting commencement date of the Reporting Person's first stock option award from the Issuer, and the remaining shares underlying the option vest in equal monthly installments thereafter, in each case subject to continued service with the Issuer. The Reporting Person can elect to exercise the stock option at any time, provided that the shares acquired upon exercise remain subject to the applicable vesting schedule.
/s/ David Ritenour, Attorney-in-Fact
2021-11-09