SEC Filing | Broadcom Inc.

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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^*

Maslowski Anthony E.

(Last)

(First)

(Middle)

C/O AVAGO TECHNOLOGIES U.S. INC.

350 WEST TRIMBLE ROAD

(Street)

SAN JOSE

95131

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
03/08/2013

3. Issuer Name and Ticker or Trading Symbol
Avago Technologies LTD [ AVGO ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director		10% Owner
	Officer (give title below)	X	Other (specify below)
Interim Chief Financial Officr

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	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)
Ordinary Shares	19,501⁽¹⁾	D

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Stock Options (right to buy)	06/30/2013	07/30/2018	Ordinary Shares	2,000	10.68	D
Stock Options (right to buy)	06/30/2013	07/30/2018	Ordinary Shares	2,000	10.68	D
Stock Options (right to buy)	03/03/2014	03/02/2019	Ordinary Shares	3,000	10	D
Stock Options (right to buy)	08/05/2013	08/04/2019	Ordinary Shares	7,500	15	D
Stock Options (right to buy)	12/01/2013	11/30/2019	Ordinary Shares	20,000	15.96	D
Stock Options (right to buy)	⁽²⁾	09/07/2020	Ordinary Shares	20,000	20.08	D
Stock Options (right to buy)	⁽³⁾	03/05/2019	Ordinary Shares	25,000	35.31	D

Explanation of Responses:

1. Includes 15,001 restricted share units ("RSUs"). Upon the vesting thereof, the Reporting Person is entitled to receive one (1) ordinary share for each one (1) RSU. 6,667 of these RSUs vest as to 50% on each of September 11, 2013 and September 10, 2014 and 8,334 of these RSUs vest as to 50% on each of March 10, 2015 and March 8, 2016.

2. Option vests in two (2) successive and equal installments on September 8, 2013 and September 8, 2014.

3. Option vests in two (2) successive and equal installments on March 6, 2015 and March 6, 2016.

Remarks:

	/s/Patricia H. McCall, Attorney-in-Fact for Anthony E. Maslowski	03/11/2013
	** 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.