0001209191-21-003765.txt : 20210115 0001209191-21-003765.hdr.sgml : 20210115 20210115161938 ACCESSION NUMBER: 0001209191-21-003765 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210113 FILED AS OF DATE: 20210115 DATE AS OF CHANGE: 20210115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rabois Keith CENTRAL INDEX KEY: 0001539865 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 21532332 MAIL ADDRESS: STREET 1: C/O YELP! INC. STREET 2: 706 MISSION ST. CITY: SAN FRANCISCO STATE: CA ZIP: 94103 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 doc4.xml FORM 4 SUBMISSION X0306 4 2021-01-13 0 0001820953 Affirm Holdings, Inc. AFRM 0001539865 Rabois Keith ONE LETTERMAN DRIVE BUILDING D, 5TH FLOOR SAN FRANCISCO CA 94129 1 0 0 0 Class A Common Stock 2021-01-13 4 P 0 75000 49.00 A 75000 I By The Founders Fund Affirm Growth, LLC Class A Common Stock 2205293 I By The Founders Fund VI, LP Class A Common Stock 545294 I By The Founders Fund VI Principals Fund, LP Class A Common Stock 27418 I By The Founders Fund VI Entrepreneurs Fund, LP Class A Common Stock 936909 I By The Founders Fund Growth, LP Class A Common Stock 60429 I By The Founders Fund Growth Principals Fund, LP The Reporting Person has shared voting and investment power over the shares held by each of The Founders Fund Affirm Growth, LLC, The Founders Fund VI, LP, The Founders Fund VI Principals Fund, LP, The Founds Fund VI Entrepreneurs Fund, LP, The Founders Fund Growth, LP and The Founders Fund Growth Principals Fund, LP. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose. /s/ Sharda Caro del Castillo as attorney-in-fact 2021-01-15