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Michalek Libor – ‘4’ for 9/16/22 re: Affirm Holdings, Inc.

On:  Tuesday, 9/20/22, at 8:31pm ET   ·   For:  9/16/22   ·   As:  Director and Officer   ·   Accession #:  1628280-22-25273   ·   File #:  1-39888

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 9/20/22  Michalek Libor                    4          Dir.,Off.   1:7K   Affirm Holdings, Inc.             Workiva Inc Wde… FA01/FA

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34

Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Statement of Changes in Beneficial Ownership of     HTML      8K 
                Securities by an Insider --                                      
                wf-form4_166372025872405.xml/3.6


        

This ‘4’ Document is an XML Data File that may be rendered in various formats:

  Form 4    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 
 
Plain Text rendering:  Statement of Changes in Beneficial Ownership of Securities by an Insider — wf-form4_166372025872405.xml/3.6
 
                                                                                                                                                                                
Ownership Document
 
Schema Version:  X0306
Document Type:  4
Period of Report:  9/16/22
Not Subject to Section 16:  0
Issuer:
Issuer CIK:  1820953
Issuer Name:  Affirm Holdings, Inc.
Issuer Trading Symbol:  AFRM
Reporting Owner:
Reporting Owner ID:
Owner CIK:  1832810
Owner Name:  Michalek Libor
Reporting Owner Address:
Owner Street 1:  C/O AFFIRM HOLDINGS, INC.
Owner Street 2:  650 CALIFORNIA STREET
Owner City:  SAN FRANCISCO
Owner State:  CA
Owner ZIP Code:  94108
Owner State Description:
Reporting Owner Relationship:
Is Director?  Yes
Is Officer?  Yes
Is Ten Percent Owner?  No
Is Other?  No
Officer Title:  President, Tech., Risk & Ops
Other Text:
Non-Derivative Table:
Non-Derivative Holding:
Security Title:
Value:  Class A Common Stock
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  86,953
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Non-Derivative Holding:
Security Title:
Value:  Class A Common Stock
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  875,504
Ownership Nature:
Direct or Indirect Ownership:
Value:  I
Nature of Ownership:
Value:  Michalek 2007 Trust dated March 21, 2007
Footnote ID:  F1
Derivative Table:
Derivative Transaction:
Security Title:
Value:  Restricted Stock Units
Conversion or Exercise Price:
Footnote ID:  F2
Transaction Date:
Value:  9/16/22
Transaction Coding:
Transaction Form Type:  4
Transaction Code:  A
Equity Swap Involved?  No
Transaction Amounts:
Transaction Shares:
Value:  112,107
Transaction Price Per Share:
Value:  0
Transaction Acquired-Disposed Code:
Value:  A
Exercise Date:
Footnote ID:  F3
Expiration Date:
Footnote ID:  F3
Underlying Security:
Underlying Security Title:
Value:  Class A Common Stock
Underlying Security Shares:
Value:  112,107.0
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  112,107
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Derivative Transaction:
Security Title:
Value:  Stock Option (Right to Buy)
Conversion or Exercise Price:
Value:  22.3
Transaction Date:
Value:  9/16/22
Transaction Coding:
Transaction Form Type:  4
Transaction Code:  A
Equity Swap Involved?  No
Transaction Amounts:
Transaction Shares:
Value:  204,750
Transaction Price Per Share:
Value:  0
Transaction Acquired-Disposed Code:
Value:  A
Exercise Date:
Footnote ID:  F4
Expiration Date:
Value:  9/16/32
Underlying Security:
Underlying Security Title:
Value:  Class A Common Stock
Underlying Security Shares:
Value:  204,750.0
Post-Transaction Amounts:
Shares Owned Following Transaction:
Value:  204,750
Ownership Nature:
Direct or Indirect Ownership:
Value:  D
Footnotes:
Footnote - F1:  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.
Footnote - F2:  Each Restricted Stock Unit (RSU) represents a contingent right to receive one share of the Issuer's Class A Common Stock.
Footnote - F3:  The RSUs vest in 48 equal monthly installments beginning October 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date. This grant has no expiration date.
Footnote - F4:  The stock options vest in 48 equal monthly installments beginning October 1, 2022, subject to the Reporting Person's continuous service with the Issuer as of each vesting date.
Remarks:
Owner Signature:
Signature Name:  /s/ David Ritenour, Attorney-in-Fact
Signature Date:  9/20/22


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Filing Submission 0001628280-22-025273   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)
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