0001628280-21-024519.txt : 20211203
0001628280-21-024519.hdr.sgml : 20211203
20211203170428
ACCESSION NUMBER: 0001628280-21-024519
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211201
FILED AS OF DATE: 20211203
DATE AS OF CHANGE: 20211203
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: 211470929
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_163856905117305.xml
FORM 4
X0306
4
2021-12-01
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
2021-12-01
4
M
0
3863
0
A
6731
D
Class A Common Stock
2021-12-01
4
F
0
1671
116.57
D
5060
D
Restricted Stock Units
2021-12-01
4
M
0
1262
0
D
2027-10-26
Class A Common Stock
1262.0
42886
D
Restricted Stock Units
2021-12-01
4
M
0
1440
0
D
2027-10-26
Class A Common Stock
1440.0
11520
D
Restricted Stock Units
2021-12-01
4
M
0
896
0
D
2027-12-31
Class A Common Stock
896.0
11646
D
Restricted Stock Units
2021-12-01
4
M
0
98
0
D
2028-07-14
Class A Common Stock
98.0
4223
D
Restricted Stock Units
2021-12-01
4
M
0
167
0
D
2026-08-22
Class A Common Stock
167.0
2667
D
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 restricted stock units that vested on December 1, 2021.
Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock.
RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of forty-eight months beginning on October 1, 2020, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of twenty-four months beginning on August 1, 2020, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in monthly installments for a period of twenty-four months beginning on January 1, 2021, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
RSUs vest with respect to the shares of Class A Common Stock underlying the RSUs in equal monthly installments for a period of forty-eight months beginning on July 1, 2021, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
RSUs vest with respect to the shares of Class A Common Stock underlying the restricted stock units in equal monthly installments for a period of forty-eight months beginning on April 1, 2019, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
/s/ David Ritenour, Attorney-in-Fact
2021-12-03