SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Eggers Barry

(Last) (First) (Middle)
2200 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/13/2021
3. Issuer Name and Ticker or Trading Symbol
Affirm Holdings, Inc. [ AFRM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class A Common Stock 934,988 I By Lightspeed Venture Partners Select II, L.P.(1)
Class A Common Stock 2,459,558 I By Lightspeed Venture Partners Select, L.P.(2)
Class A Common Stock 1,254,623 I By Lightspeed Opportunity Fund, L.P.(3)
Class A Common Stock 4,721,064 I By Lightspeed Venture Partners IX, L.P.(4)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (5) (5) Class A Common Stock 934,988 (5) I By Lightspeed Venture Partners Select II, L.P.(1)
Class B Common Stock (5) (5) Class A Common Stock 2,459,558 (5) I By Lightspeed Venture Partners Select, L.P.(2)
Class B Common Stock (5) (5) Class A Common Stock 1,254,623 (5) I By Lightspeed Opportunity Fund, L.P.(3)
Class B Common Stock (5) (5) Class A Common Stock 4,721,064 (5) I By Lightspeed Venture Partners IX, L.P.(4)
1. Name and Address of Reporting Person*
Eggers Barry

(Last) (First) (Middle)
2200 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Mhatre Ravi

(Last) (First) (Middle)
2200 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Nieh Peter

(Last) (First) (Middle)
2200 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
Explanation of Responses:
1. Shares held by Lightspeed Venture Partners Select II, L.P. ("Lightspeed Select II"). Lightspeed General Partner Select II, L.P. ("LGP Select II") is the general partner of Lightspeed Select II. Lightspeed Ultimate General Partner Select II, Ltd. ("LUGP Select II") is the general partner of LGP Select II. Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of LUGP Select II and share voting and dispositive power with respect to the shares held by Lightspeed Select II. LGP Select II, LUGP Select II and Messrs. Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed Select II except to the extent of their respective pecuniary interests therein.
2. Shares held by Lightspeed Venture Partners Select, L.P. ("Lightspeed Select"). Lightspeed General Partner Select, L.P. ("LGP Select") is the general partner of Lightspeed Select. Lightspeed Ultimate General Partner Select, Ltd. ("LUGP Select") is the general partner of LGP Select. Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of LUGP Select and share voting and dispositive power with respect to the shares held by Lightspeed Select. LGP Select, LUGP Select and Messrs. Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed Select except to the extent of their respective pecuniary interests therein.
3. Shares held by Lightspeed Opportunity Fund, L.P. ("Lightspeed Opportunity"). Lightspeed General Partner Opportunity, L.P. ("LGP Opportunity") is the general partner of Lightspeed Opportunity. Lightspeed Ultimate General Partner Opportunity, Ltd. ("LUGP Opportunity") is the general partner of LGP Opportunity. Jeremy Liew, Ravi Mhatre and Arif Janmohamed are the directors of LUGP Opportunity and share voting and dispositive power with respect to the shares held by Lightspeed Opportunity. LGP Opportunity, LUGP Opportunity and Messrs. Liew, Mhatre and Janmohamed disclaim beneficial ownership of the shares held by Lightspeed Opportunity except to the extent of their respective pecuniary interests therein.
4. Shares held by Lightspeed Venture Partners IX, L.P. ("Lightspeed IX"). Lightspeed General Partner IX, L.P. ("LGP IX") is the general partner of Lightspeed IX. Lightspeed Ultimate General Partner IX, Ltd. ("LUGP IX") is the general partner of LGP IX. Barry Eggers, Ravi Mhatre and Peter Nieh are the directors of LUGP IX and share voting and dispositive power with respect to the shares held by Lightspeed IX. LGP IX, LUGP IX and Messrs. Eggers, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed IX except to the extent of their respective pecuniary interests therein.
5. Each share of the Issuer's Class B common stock, par value $0.00001 per share ("Class B Common Stock"), is convertible at any time into one share of the Issuer's Class A common stock, par value $0.00001 per share ("Class A Common Stock"). The Class B Common Stock has no expiration date.
Remarks:
/s/ Barry Eggers 01/14/2021
/s/ Ravi Mhatre 01/14/2021
/s/ Peter Nieh 01/14/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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