# EDGAR Filing Document

**Accession Number:** 0001820953
**File Stem:** 0001628280-23-002257
**Filing Date:** 2023-2
**Character Count:** 7847
**Document Hash:** b785a36efe1855e591b2187198a986da
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-23-002257.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001628280-23-002257

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230201

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Rabois Keith
- **CENTRAL INDEX KEY:** 0001539865

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39888
- **FILM NUMBER:** 23587694

**MAIL ADDRESS:**
- **STREET 1:** C/O YELP! INC.
- **STREET 2:** 706 MISSION ST.
- **CITY:** SAN FRANCISCO
- **STATE:** CA
- **ZIP:** 94103
**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Rabois Keith<br><sub>(Last) (First) (Middle)</sub><br>ONE LETTERMAN DRIVE<br>BUILDING D, 5TH FLOOR<br><sub>(Street)</sub><br>SAN FRANCISCO, CA 94129<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-01 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Affirm Holdings, Inc. [ AFRM ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Class A Common Stock | 2023-02-01 |  | S |  | 10800<sup>(1)</sup> | D | 16.1948<sup>(2)</sup> | 41060 | D |  |
| Class A Common Stock | 2023-02-01 |  | S |  | 4487<sup>(1)</sup> | D | 17.4192<sup>(3)</sup> | 36573 | D |  |
| Class A Common Stock | 2023-02-01 |  | S |  | 2000<sup>(1)</sup> | D | 17.8635<sup>(4)</sup> | 34573 | D |  |
| Class A Common Stock |  |  |  |  |  |  |  | 75000 | I | By FF Affirm Growth, LLC<sup>(5)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 1486909 | I | By The Founders Fund Growth, LP<sup>(5)</sup> |
| Class A Common Stock |  |  |  |  |  |  |  | 60429 | I | By The Founders Fund Growth Principals Fund, LP<sup>(5)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on September 15, 2022.

(2) Represents the weighted average sale price of the shares sold from $15.73 to $16.69 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.

(3) Represents the weighted average sale price of the shares sold from $16.75 to $17.74 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.

(4) Represents the weighted average sale price of the shares sold from $17.75 to $17.99 per share. The Reporting Person will provide, upon request by the Commission staff, the Issuer, or a security holder of the Issuer, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.

(5) The Reporting Person has shared voting and investment power over the shares held by each of The Founders Fund VI, LP, The Founders Fund VI Principals Fund, LP, The Founders Fund VI Entrepreneurs Fund, LP, The Founders Fund Growth, LP, The Founders Fund Growth Principals Fund, LP and FF Affirm Growth, LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose.

**Signature:** /s/ David Ritenour, Attorney-in-Fact  
**Date:** 2023-02-03

### Remarks:

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 4 (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.**