0001628280-24-014728.txt : 20240403 0001628280-24-014728.hdr.sgml : 20240403 20240403180135 ACCESSION NUMBER: 0001628280-24-014728 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240401 FILED AS OF DATE: 20240403 DATE AS OF CHANGE: 20240403 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jiyane Siphelele CENTRAL INDEX KEY: 0001832806 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39888 FILM NUMBER: 24820547 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] ORGANIZATION NAME: 02 Finance 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) 960-1518 MAIL ADDRESS: STREET 1: 650 CALIFORNIA STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94108 4 1 wk-form4_1712181671.xml FORM 4 X0508 4 2024-04-01 0 0001820953 Affirm Holdings, Inc. AFRM 0001832806 Jiyane Siphelele C/O AFFIRM HOLDINGS, INC. 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 0 1 0 0 Chief Accounting Officer 0 Class A Common Stock 2024-04-01 4 M 0 25000 0 A 222775 D Class A Common Stock 2024-04-01 4 F 0 9838 34.83 D 212937 D Restricted Stock Units 2024-04-01 4 M 0 25000 0 D Class A Common Stock 25000 0 D Represents the number of shares of the Issuer's Common Stock withheld to satisfy the Reporting Person's tax obligation in connection with the settlement of shares of Common Stock underlying the Reporting Person's restricted stock units that vested on April 1, 2024. Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock. The RSUs vest in four equal quarterly installments beginning July 1, 2023, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. /s/ Josh Samples, Attorney-in-Fact 2024-04-03