0001628280-22-000451.txt : 20220106 0001628280-22-000451.hdr.sgml : 20220106 20220106180134 ACCESSION NUMBER: 0001628280-22-000451 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220104 FILED AS OF DATE: 20220106 DATE AS OF CHANGE: 20220106 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: 22515936 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: PERSONAL CREDIT INSTITUTIONS [6141] 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_164151007981141.xml FORM 4 X0306 4 2022-01-04 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 1663 D Stock Option (Right to Buy) 85.41 2022-01-04 4 A 0 30615 0 A 2032-01-04 Class A Common Stock 30615.0 30615 D Restricted Stock Units 2022-01-04 4 A 0 14636 0 A Class A Common Stock 14636.0 14636 D The stock option vests in 48 equal monthly installments beginning February 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock. The RSUs vest in 48 equal monthly installments beginning February 1, 2022, 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 2022-01-06