Founders Fund V, LP - May 21, 2021 Form 4 Insider Report for Affirm Holdings, Inc. (AFRM)

Role
10%+ Owner
Signature
The Founders Fund V, LP, By The Founders Fund Management V LLC, General Partner, By /s/ Brian Singerman, Managing Member
Stock symbol
AFRM
Transactions as of
May 21, 2021
Transactions value $
$0
Form type
4
Date filed
5/25/2021, 08:18 PM
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction AFRM Class A Common Stock Other $0 -3.99M -100% $0.00* 0 May 21, 2021 Direct F1, F2
transaction AFRM Class A Common Stock Other $0 -1.07M -100% $0.00* 0 May 21, 2021 Direct F1, F3
transaction AFRM Class A Common Stock Other $0 -56.5K -100% $0.00* 0 May 21, 2021 Direct F1, F4

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction AFRM Class B Common Stock Other $0 -3.99M -100% $0.00* 0 May 21, 2021 Class A Common Stock 3.99M Direct F2, F5, F6
transaction AFRM Class B Common Stock Other $0 -1.07M -100% $0.00* 0 May 21, 2021 Class A Common Stock 1.07M Direct F3, F5, F6
transaction AFRM Class B Common Stock Other $0 -56.5K -100% $0.00* 0 May 21, 2021 Class A Common Stock 56.5K Direct F4, F5, F6
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Founders Fund V, LP is no longer subject to Section 16 filing requirements. Form 4 or Form 5 obligations may continue.

Explanation of Responses:

Id Content
F1 Represents a pro rata distribution of shares of Class A Common Stock, without additional consideration, by the holder to its general partner and limited partners.
F2 Shares held by The Founders Fund V, LP.
F3 Shares held by The Founders Fund V Principals Fund, LP.
F4 Shares held by The Founders Fund V Entrepreneurs Fund, LP.
F5 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.
F6 Represents a pro rata distribution of shares of Class B Common Stock, without additional consideration, by the holder to its general partner and limited partners.