0001628280-23-032875.txt : 20230922
0001628280-23-032875.hdr.sgml : 20230922
20230922181154
ACCESSION NUMBER: 0001628280-23-032875
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: Adkins Katherine
CENTRAL INDEX KEY: 0001870331
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39888
FILM NUMBER: 231272704
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_1695420704.xml
FORM 4/A
X0508
4/A
2023-09-13
2023-09-15
0
0001820953
Affirm Holdings, Inc.
AFRM
0001870331
Adkins Katherine
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO
CA
94108
0
1
0
0
Chief Legal Officer
0
Class A Common Stock
72722
D
Restricted Stock Units
2023-09-13
4
A
0
81370
0
A
Class A Common Stock
81370
81370
D
Stock Option (Right to Buy)
23.35
2023-09-13
4
A
0
118012
0
A
2033-09-13
Class A Common Stock
118012
118012
D
Each Restricted Stock Unit represents a contingent right to receive one share of the Issuer's Class A Common Stock.
The RSUs vest in 16 equal quarterly installments beginning September 1, 2024, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date.
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