0001628280-22-031379.txt : 20221205 0001628280-22-031379.hdr.sgml : 20221205 20221205180400 ACCESSION NUMBER: 0001628280-22-031379 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221201 FILED AS OF DATE: 20221205 DATE AS OF CHANGE: 20221205 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: 221446105 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_167028141883023.xml FORM 4 X0306 4 2022-12-01 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 2022-12-01 4 M 0 3535 0 A 95150 D Class A Common Stock 2022-12-01 4 F 0 1442 14.41 D 93708 D Restricted Stock Units 2022-12-01 4 M 0 167 0 D 2026-08-22 Class A Common Stock 167.0 667 D Restricted Stock Units 2022-12-01 4 M 0 1262 0 D 2027-10-26 Class A Common Stock 1262.0 27750 D Restricted Stock Units 2022-12-01 4 M 0 896 0 D 2027-12-31 Class A Common Stock 896.0 896 D Restricted Stock Units 2022-12-01 4 M 0 99 0 D 2028-07-14 Class A Common Stock 99.0 3044 D Restricted Stock Units 2022-12-01 4 M 0 555 0 D Class A Common Stock 555.0 3889 D Restricted Stock Units 2022-12-01 4 M 0 556 0 D Class A Common Stock 556.0 17779 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, 2022. 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 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. 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 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 RSUs in 12 equal monthly installments beginning August 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date. RSUs vest with respect to the shares of Class A common stock underlying the RSUs in 36 equal monthly installments beginning September 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 2022-12-05