FORM 5
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

                                                                                  

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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

SAMUELI HENRY

2. Issuer Name and Ticker or Trading Symbol

Broadcom Ltd [AVGO]

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

__ X __ Director                      _____ 10% Owner
__ X __ Officer (give title below)      _____ Other (specify below)
Chief Technical Officer

(Last)          (First)          (Middle)

C/O AVAGO TECHNOLOGIES US INC.,  1320 RIDDER PARK DRIVE

3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY)
10/29/2017 
(Street)

SAN JOSE, CA 95131

(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
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 Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Amount (A) or (D) Price

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Trans. Date 3A. Deemed Execution Date, if any 4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Exchangeable Units   (1)   4/10/2017     W   2879         (1)   (1) Ordinary Shares, no par value   2879.0   $0   2879   I   See Footnote   (2)
Exchangeable Units   (1)   9/19/2017     G   (3)    2879      (1)   (1) Ordinary Shares, no par value   2879.0   $0   0   I   See Footnote   (3)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   53649.0     53649   D    
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   40058.0     40058   I   See Footnote   (4)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   40058.0     40058   I   See Footnote   (5)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   5752978.0     5752978   I   See Footnote   (6)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   399918.0     399918   I   See Footnote   (7)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   459690.0     459690   I   See Footnote   (8)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   2766772.0     2766772   I   See Footnote   (9)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   1860.0     1860   I   See Footnote   (10)
Exchangeable Units   (1)                   (1)   (1) Ordinary Shares, no par value   58800.0     58800   I   See Footnote   (11)

Explanation of Responses:
(1)  Each Broadcom Cayman LP exchangeable unit ("the Exchangeable Unit") is convertible, at the holder's election, at any time after February 1, 2017, into ordinary shares of the Issuer or a cash amount equal to a prescribed cash amount determined by reference to the weighted average trading price of the Issuer's ordinary shares on NASDAQ for the trading day ending on the last business day prior to the date on which an exchange notice is delivered, at the sole discretion of the Issuer, as the general partner of Broadcom Cayman LP. This conversion right has no expiration date.
(2)  Directly held by the Eisenberg 2005 Revocable Trust for which the Reporting Person's spouse is trustee and acquired dispositive power over these Exchangeable Units upon death of the initial trustee (the Reporting Person's mother-in-law).
(3)  Charitable gifts by the Eisenberg 2005 Revocable Trust.
(4)  Indirectly held by Henry Samueli 2016 GRAT through ownership of membership interests in HS REU, LLC, the direct holder of the Exchangeable Units.
(5)  Indirectly held by Susan Faye Samueli 2016 GRAT, a trust for the benefit of the Reporting Person's spouse, through ownership of membership interests in SFS REU, LLC, the direct holder of the Exchangeable Units. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(6)  Directly held by HS Portfolio L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(7)  Directly held by HS Management, L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(8)  Directly held by H&S Portfolio II L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(9)  Directly held by H&S Investments I L.P. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(10)  Directly held by H&S Ventures LLC. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
(11)  Indirectly held by Samueli 1995 Exempt Gifting Trust. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
SAMUELI HENRY
C/O AVAGO TECHNOLOGIES US INC.
1320 RIDDER PARK DRIVE
SAN JOSE, CA 95131
X
Chief Technical Officer

Signatures
/s/ Noelle Matteson, Attorney-in-Fact for Henry Samueli 12/8/2017
** 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 4(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 control number.
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