0001628280-23-015321.txt : 20230503
0001628280-23-015321.hdr.sgml : 20230503
20230503175945
ACCESSION NUMBER: 0001628280-23-015321
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230501
FILED AS OF DATE: 20230503
DATE AS OF CHANGE: 20230503
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: 23885679
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_168315116289828.xml
FORM 4
X0407
4
2023-05-01
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
0
Class A Common Stock
2023-05-01
4
M
0
2469
0
A
111446
D
Class A Common Stock
2023-05-01
4
F
0
627
9.99
D
110819
D
Restricted Stock Units
2023-05-01
4
M
0
1260
0
D
2027-10-26
Class A Common Stock
1260.0
21444
D
Restricted Stock Units
2023-05-01
4
M
0
99
0
D
2028-07-14
Class A Common Stock
99.0
2553
D
Restricted Stock Units
2023-05-01
4
M
0
555
0
D
Class A Common Stock
555.0
1111
D
Restricted Stock Units
2023-05-01
4
M
0
555
0
D
Class A Common Stock
555.0
15002
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 May 1, 2023.
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 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
2023-05-03