0001628280-23-024331.txt : 20230705 0001628280-23-024331.hdr.sgml : 20230705 20230705180347 ACCESSION NUMBER: 0001628280-23-024331 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230703 FILED AS OF DATE: 20230705 DATE AS OF CHANGE: 20230705 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Liew Jeremy CENTRAL INDEX KEY: 0001700539 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 231071126 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 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 wk-form4_1688594619.xml FORM 4 X0407 4 2023-07-03 0 0001820953 Affirm Holdings, Inc. AFRM 0001700539 Liew Jeremy C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 1 0 0 0 0 Class A Common Stock 2023-07-03 4 A 0 2791 0 A 352019 D Grant of Restricted Stock Units (RSUs) under the Issuer's Amended and Restated 2012 Stock Plan. The RSUs will vest in full on July 1, 2024. Each RSU represents a contingent right to receive one share of the Issuer's Class A Common Stock. Reflects the receipt of 144,118 shares of Class A common stock pursuant to a pro rata distribution effected by Lightspeed Venture Partners IX LP to its members, including the Reporting Person, for no additional consideration. Reflects the receipt of 63,653 shares of Class A Common Stock pursuant to a pro rata distribution effected by Lightspeed Venture Partners Select LP to its members, including the Reporting Person, for no additional consideration. /s/ David Ritenour, Attorney-in-Fact 2023-07-05