Sec Form 3 Filing - Liew Jeremy @ Affirm Holdings, Inc. - 2021-01-13

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Liew Jeremy
2. Issuer Name and Ticker or Trading Symbol
Affirm Holdings, Inc. [ AFRM]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O AFFIRM HOLDINGS, INC., 650 CALIFORNIA STREET
3. Date of Earliest Transaction (MM/DD/YY)
01/13/2021
(Street)
SAN FRANCISCO, CA94108
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 934,988 I By Lightspeed Venture Partners Select II, L.P. ( 1 ) ( 2 )
Class A Common Stock 2,459,558 I By Lightspeed Venture Partners Select, L.P. ( 1 ) ( 2 )
Class A Common Stock 1,254,623 I By Lightspeed Opportunity Fund, L.P. ( 1 ) ( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock ( 3 ) ( 3 ) ( 3 ) Class A Common Stock 934,988 I By Lightspeed Venture Partners Select II, L.P. ( 1 ) ( 2 )
Class B Common Stock ( 3 ) ( 3 ) ( 3 ) Class A Common Stock 2,459,558 I By Lightspeed Venture Partners Select, L.P. ( 1 ) ( 2 )
Class B Common Stock ( 3 ) ( 3 ) ( 3 ) Class A Common Stock 1,254,623 I By Lightspeed Opportunity Fund, L.P. ( 1 ) ( 2 )
Restricted Stock Units ( 4 ) ( 4 ) 01/12/2028 Class A Common Stock 4,081 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Liew Jeremy
C/O AFFIRM HOLDINGS, INC.
650 CALIFORNIA STREET
SAN FRANCISCO, CA94108
X
Signatures
/s/ Sharda Caro del Castillo as Attorney-in-Fact 01/13/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Lightspeed Ultimate General Partner Select, Ltd. ("LUGP Select") is the sole general partner of Lightspeed General Partner Select, L.P., which is the sole general partner of Lightspeed Venture Partners Select, L.P. ("Lightspeed Select"). The Reporting Person is a director of LUGP Select and shares voting and dispositive power with respect to the shares held by Lightspeed Select. Lightspeed Ultimate General Partner Select II, Ltd. ("LUGP Select II") is the sole general partner of Lightspeed General Partner Select II, L.P., which is the sole general partner of Lightspeed Venture Partners Select II, L.P. ("Lightspeed Select II").The Reporting person is a director of LUGP Select II and shares voting and dispositive power with respect to the shares held by Lightspeed Select II. (continued in next footnote)
( 2 )Lightspeed Ultimate General Partner Opportunity Fund, Ltd. ("LUGP Opportunity") is the sole general partner of Lightspeed General Partner Opportunity Fund, L.P., which is the sole general partner of Lightspeed Opportunity Fund, L.P. ("Lightspeed Opportunity"). The Reporting Person is a director of LUGP Opportunity and shares voting and dispositive power with respect to the shares held by Lightspeed Opportunity. 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 for any other purpose.
( 3 )Each share of the Issuer's Class B common stock, par value $0.00001 per share ("Class B Common Stock"), is convertible at any time into one share of the Issuer's Class A common stock, par value $0.00001 per share ("Class A Common Stock"). The Class B Common Stock has no expiration date.
( 4 )Restricted stock units vest in full upon the earlier of November 18, 2021 or the date of the Issuer's next annual meeting of stockholders, subject to continued service by the Reporting Person as a non-employee director until such earlier date.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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