0001820953-21-000049.txt : 20210504
0001820953-21-000049.hdr.sgml : 20210504
20210504172020
ACCESSION NUMBER: 0001820953-21-000049
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210501
FILED AS OF DATE: 20210504
DATE AS OF CHANGE: 20210504
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: 21889911
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_162016319486989.xml
FORM 4
X0306
4
2021-05-01
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
Class A Common Stock
2021-05-01
4
M
0
3762
A
12018
D
Class A Common Stock
2021-05-01
4
F
0
1807
70.50
D
10211
D
Restricted Stock Units
2021-05-01
4
M
0
166
0
D
2026-08-22
Class A Common Stock
166.0
3834
D
Restricted Stock Units
2021-05-01
4
M
0
1440
0
D
2027-10-26
Class A Common Stock
1440.0
21600
D
Restricted Stock Units
2021-05-01
4
M
0
1260
0
D
2027-10-26
Class A Common Stock
1260.0
51716
D
Restricted Stock Units
2021-05-01
4
M
0
896
0
D
2027-12-31
Class A Common Stock
896.0
17917
D
Each restricted stock unit represents a contingent right to receive one share of the Issuer's Class A Common Stock.
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 Class A Common Stock underlying the Reporting Person's restricted stock units that vested on May 1, 2021.
Restricted stock units 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.
Restricted stock units vest with respect to the shares of Class A Common Stock underlying the restricted stock units 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.
Restricted stock units 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 October 1, 2020, the vesting commencement date, subject to the Reporting Person's continued employment with the Issuer as of each vesting date.
Restricted stock units vest with respect to the shares of Class A Common Stock underlying the restricted stock units 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.
/s/ David Ritenour, Attorney-in-Fact
2021-05-04