Affirm Holdings, Inc. — Director's Dealing 2021

Jan 14, 2021

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: Affirm Holdings, Inc. (AFRM)
CIK: 0001820953
Period of Report: 2021-01-13

Reporting Person: Khosla Ventures IV, L.P. (10% Owner)
Reporting Person: Khosla Ventures IV (CF), L.P. (10% Owner)
Reporting Person: Khosla Ventures Associates IV, LLC (10% Owner)
Reporting Person: VK Services, LLC (10% Owner)
Reporting Person: KHOSLA VINOD (10% Owner)

Holdings (Non-Derivative)

Security	Shares	Ownership
Class A Common Stock	6530470	Indirect
Class A Common Stock	417504	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Class B Common Stock	$		Class A Common Stock (6530470)		Indirect
Class B Common Stock	$		Class A Common Stock (417504)		Indirect

Footnotes

F1: 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.

F2: Consists of securities held of record by Khosla Ventures IV, L.P. ("KV IV"), of which Khosla Ventures Associates IV, LLC ("KVA IV") is the general partner. Vinod Khosla is the managing member of VK Services, LLC ("VK Services"), which is the sole manager of KVA IV. Each of KVA IV, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities held by KV IV, and each of KVA IV, VK Services and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities held by KV IV. Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its respective pecuniary interests therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.

F3: Consists of securities held of record by Khosla Ventures IV (CF), L.P. ("KV IV (CF)"), of which KVA IV is the general partner. Vinod Khosla is the managing member of VK Services, which is the sole manager of KVA IV. Each of KVA IV, VK Services and Vinod Khosla may be deemed to possess voting and investment control over such securities held by KV IV (CF), and each of KVA IV, VK Services, and Vinod Khosla may be deemed to have indirect beneficial ownership of such securities held by KV IV (CF). Each Reporting Person disclaims beneficial ownership of such shares except to the extent of his or its pecuniary interests therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purposes.

F4: 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.