0001628280-23-032873.txt : 20230922
0001628280-23-032873.hdr.sgml : 20230922
20230922181001
ACCESSION NUMBER: 0001628280-23-032873
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230913
FILED AS OF DATE: 20230922
DATE AS OF CHANGE: 20230922
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Michalek Libor
CENTRAL INDEX KEY: 0001832810
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 231272695
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/A
1
wk-form4a_1695420587.xml
FORM 4/A
X0508
4/A
2023-09-13
2023-09-15
0
0001820953
Affirm Holdings, Inc.
AFRM
0001832810
Michalek Libor
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO
CA
94108
1
1
0
0
President
0
Class A Common Stock
117468
D
Class A Common Stock
873294
I
Michalek 2007 Trust dated March 21, 2007
Stock Option (Right to Buy)
23.35
2023-09-13
4
A
0
459627
0
A
2033-09-13
Class A Common Stock
459627
459627
D
The shares are held by the Michalek 2007 Family Trust dated March 21, 2007. The Reporting Person and his spouse are trustees of the trust.
The stock options vest in 48 equal monthly installments beginning September 1, 2024, subject to the Reporting Person's continuous service with the Issuer as of each vesting date.
This Form 4/A is being filed to correct the number of stock options received by the Reporting Person on September 13, 2023 and provides corrected amounts in Columns 5, 7, and 9 of Table II.
/s/ David Ritenour, Attorney-in-Fact
2023-09-22