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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/05/2009
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3. Issuer Name and Ticker or Trading Symbol
Avago Technologies LTD
[ AVGO ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Ordinary Shares, no par value |
17,782,701 |
I |
Held through Bali Investments S.? r.l. and KKR Millennium Fund (Overseas), Limited Partnership
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Ordinary Shares, no par value |
35,407,740 |
I |
Held through Bali Investments S.? r.l. and KKR European Fund, Limited Partnership
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Ordinary Shares, no par value |
23,748,545 |
I |
Held through Bali Investments S.? r.l. and KKR European Fund II, Limited Partnership
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Ordinary Shares, no par value |
3,144,049 |
I |
Held through Bali Investments S.? r.l. and KKR Partners (International), Limited Partnership
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Ordinary Shares, no par value |
12,123,637 |
I |
Held through Bali Investments S.? r.l. and Avago Investment Partners, Limited Partnership
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Stock Options (right to buy)
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04/13/2011 |
Ordinary Shares |
50,000 |
5 |
D |
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
|
1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
|
1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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1. Name and Address of Reporting Person*
C/O KOHLBERG KRAVIS ROBERTS & CO. L.P. |
9 WEST 57TH STREET, SUITE 4200 |
(Street)
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Explanation of Responses: |
Remarks: |
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See signatures of Reporting Persons attached as Exhibit 99.1 |
08/05/2009 |
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** 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). |
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. |
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Exhibit 99.1
Joint Filer Information
Date of Event Requiring Statement: August 5, 2009
Issuer Name and Ticker or Trading Symbol: Avago Technologies Limited (AVGO)
Designated Filer: KKR 1996 Overseas, Limited
Other Joint Filers: KKR Partners (International), Limited Partnership
Reinhard Gorenflos
Joseph Y. Bae
Brian F. Carroll
John K. Saer, Jr.
Scott C. Nuttall
Michael M. Calbert
William J. Janetschek
Addresses: The principal business address of the Joint Filers above is
c/o Kohlberg Kravis Roberts & Co., 9 West 57th Street,
New York, NY 10019, U.S.
Signatures:
KKR 1996 Overseas, Limited
By: /s/ William J. Janetschek
-----------------------------------------------
Name: William J. Janetschek
Title: Director
KKR Partners (International), Limited Partnership
By: KKR 1996 Overseas, Limited, its general partner
By: /s/ William J. Janetschek
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Name: William J. Janetschek
Title: Director
/s/ William J. Janetschek
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William J. Janetschek, as attorney-in-fact for Reinhard Gorenflos
/s/ William J. Janetschek
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William J. Janetschek, as attorney-in-fact for Joseph Y. Bae
/s/ William J. Janetschek
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William J. Janetschek, as attorney-in-fact for Brian F. Carroll
/s/ William J. Janetschek
--------------------------------------------
William J. Janetschek, as attorney-in-fact for John K. Saer, Jr.
/s/ William J. Janetschek
--------------------------------------------
William J. Janetschek, as attorney-in-fact for Scott C. Nuttall
/s/ William J. Janetschek
--------------------------------------------
William J. Janetschek, as attorney-in-fact for Michael M. Calbert
/s/ William J. Janetschek
--------------------------------------------
William J. Janetschek
rrd223859_252745.html
POWER OF ATTORNEY
Know all men by these presents that Reinhard Gorenflos does hereby make,
constitute and appoint William J. Janetschek and Richard J. Kreider, or either
one of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned (both in the undersigned's individual capacity and as a member
of any limited liability company or as a partner of any partnership for which
the undersigned is otherwise authorized to sign), to execute and deliver such
forms as may be required to be filed from time to time with the Securities and
Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 13G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
/s/ Reinhard Gorenflos
---------------------------------------
Name: Reinhard Gorenflos
Date: July 31, 2005
rrd223859_252746.html
POWER OF ATTORNEY
Know all men by these presents that Joseph Y. Bae does hereby make, constitute
and appoint William J. Janetschek and Richard J. Kreider, or either one of them,
as a true and lawful attorney-in-fact of the undersigned with full powers of
substitution and revocation, for and in the name, place and stead of the
undersigned in the undersigned's individual capacity to execute and deliver such
forms as may be required to be filed from time to time with the Securities and
Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 14G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
Joseph Y. Bae
---------------------------------------
Name: Joseph Y. Bae
Date: November 20, 2002
rrd223859_252747.html
POWER OF ATTORNEY
Know all men by these presents that Brian F. Carroll does hereby make,
constitute and appoint William J. Janetschek and Richard J. Kreider, or either
one of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned in the undersigned's individual capacity to execute and deliver
such forms as may be required to be filed from time to time with the Securities
and Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 14G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
/s/ Brian F. Carroll
---------------------------------------
Name: Brian F. Carroll
Date: November 20, 2002
rrd223859_252748.html
POWER OF ATTORNEY
Know all men by these presents that John K. Saer, Jr. does hereby make,
constitute and appoint William J. Janetschek and Richard J. Kreider, or either
one of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned in the undersigned's individual capacity to execute and deliver
such forms as may be required to be filed from time to time with the Securities
and Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 14G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
/s/ John K. Saer, Jr.
----------------------------------------
Name: John K. Saer, Jr.
Date: November 20, 2002
rrd223859_252749.html
POWER OF ATTORNEY
Know all men by these presents that Scott C. Nuttall does hereby make,
constitute and appoint William J. Janetschek and Richard J. Kreider, or either
one of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned (both in the undersigned's individual capacity and as a member
of any limited liability company or as a partner of any partnership for which
the undersigned is otherwise authorized to sign), to execute and deliver such
forms as may be required to be filed from time to time with the Securities and
Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 13G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
/s/ Scott C. Nuttall
----------------------------------------
Name: Scott C. Nuttall
Date: July 31, 2005
rrd223859_252750.html
POWER OF ATTORNEY
Know all men by these presents that Michael M. Calbert does hereby make,
constitute and appoint William J. Janetschek and Richard J. Kreider, or either
one of them, as a true and lawful attorney-in-fact of the undersigned with full
powers of substitution and revocation, for and in the name, place and stead of
the undersigned (both in the undersigned's individual capacity and as a member
of any limited liability company or as a partner of any partnership for which
the undersigned is otherwise authorized to sign), to execute and deliver such
forms as may be required to be filed from time to time with the Securities and
Exchange Commission with respect to: (i) Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934, as amended (the "Act"), including without
limitation, Schedule 13D, Schedule 13G, statements on Form 3, Form 4 and Form 5
and (ii) in connection with any applications for EDGAR access codes, including
without limitation the Form ID.
/s/ Michael M. Calbert
---------------------------------------
Name: Michael M. Calbert
Date: July 31, 2005