SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
GIC Private Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/18/2022
3. Issuer Name and Ticker or Trading Symbol
Affirm Holdings, Inc. [ AFRM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Class A Common Stock 677,889 D
Class A Common Stock 11,826,097 I See Footnotes(1)(2)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (3) (3) Class A Common Stock 11,003,703 (3) I See Footnotes(1)(2)
1. Name and Address of Reporting Person*
GIC Private Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
1. Name and Address of Reporting Person*
GIC Special Investments Pte Ltd

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
1. Name and Address of Reporting Person*
JASMINE VENTURES PTE. LTD.

(Last) (First) (Middle)
168 ROBINSON ROAD
#37-01 CAPITAL TOWER

(Street)
SINGAPORE U0 068912

(City) (State) (Zip)
Explanation of Responses:
1. These securities are owned directly by Jasmine Ventures Pte Ltd ("Jasmine"). Jasmine is controlled and managed by GIC Special Investments Pte Ltd ("GIC SI"), which in turn is a wholly-owned subsidiary of GIC Private Ltd ("GIC," and with Jasmine and GIC SI, each a "Reporting Person"). As such, each of Jasmine, GIC SI and GIC may be deemed to share the power to vote and the power to dispose of these securities. GIC is wholly owned by the Government of Singapore and was set up with the sole purpose of managing Singapore's foreign reserves. The Government of Singapore disclaims beneficial ownership of these shares.
2. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of the shares for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.
3. 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.
Remarks:
GIC Private Ltd, By: /s/ Celine Loh Sze Ling, Name: Celine Loh Sze Ling, Title: Senior Vice President 04/21/2022
By: /s/ Diane Liang, Name: Diane Liang, Title: Senior Vice President 04/21/2022
GIC Special Investments Pte Ltd, By: /s/ Chan Hoe Yin, Name: Chan Hoe Yin, Title: Director 04/21/2022
Jasmine Ventures Pte Ltd, By: /s/ Ankur Meattle, Name: Ankur Meattle, Title: Director 04/21/2022
** Signature of Reporting Person Date
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 5 (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).
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