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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
GIC Private Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01, CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(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(1) 11,003,703 I See Footnotes(2)(3)
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 (4) (4) Class A Common Stock(1) 11,003,703 (4) I See Footnotes(2)(3)
1. Name and Address of Reporting Person*
GIC Private Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01, CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
1. Name and Address of Reporting Person*
GIC Special Investments Pte Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
1. Name and Address of Reporting Person*
JASMINE VENTURES PTE. LTD.

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
Explanation of Responses:
1. Reflects the conversion of each share of the Issuer's Preferred Stock into Common Stock, and the conversion in turn of each share of the Issuer's Common Stock into one half of one share of Class A Common Stock and one half of one share of Class B Common Stock immediately prior to the consummation of the Issuer's initial public offering of Class A Common Stock.
2. These securities are owned directly by Jasmine Ventures Pte Ltd ("Jasmine"). Jasmine is controlled and managed by GIC Special Investments Pte Ltd ("GIC SI"), which in turn is a wholly-owned subsidiary of GIC Private Ltd ("GIC," and with Jasmine and GIC SI, each a "Reporting Person"). As such, each of Jasmine, GIC SI and GIC may be deemed to share the power to vote and the power to dispose of these securities.
3. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of the shares for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
4. Each share of the Issuer's Class B Common Stock is convertible at any time into one share of the Issuer's Class A Common Stock. The Class B Common Stock has no expiration date.
Remarks:
GIC Private Ltd, By: /s/ Celine Loh Sze Ling, Name: Celine Loh Sze Ling, Title: Senior Vice President, By: /s/ Toh Tze Meng, Name: Toh Tze Meng, Title: Senior Vice President 01/19/2021
GIC Special Investments Pte Ltd, By: /s/ Chan Hoe Yin, Name: Chan Hoe Yin, Title: Director 01/19/2021
Jasmine Ventures Pte Ltd, By: /s/ Ankur Meattle, Name: Ankur Meattle, Title: Director 01/19/2021
** 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.