Broadcom : Initial filing by director officer or owner of more than ten percent.

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION

OMB APPROVAL

Washington, D.C. 20549

OMB Number:

3235-0104

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF

Estimated average burden

hours per response:

0.5

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

1. Name and Address of Reporting Person *

2. Date of Event Requiring

3. Issuer Name and Ticker or Trading Symbol

FERNANDEZ RAUL J

(Month/Day/Year)

Broadcom Inc.[ AVGO ]

Statement

01/10/2020

4. Relationship of Reporting Person(s) to Issuer

5. If Amendment, Date of Original Filed

(Last)

(First)

(Middle)

(Check all applicable)

(Month/Day/Year)

C/O BROADCOM INC.

X Director

10% Owner

6. Individual or Joint/Group Filing (Check

Officer (give title

Other (specify

1320 RIDDER PARK DRIVE

Applicable Line)

below)

below)

X Form filed by One Reporting Person

Form filed by More than One

(Street)

Reporting Person

SAN JOSE

CA

95131

(City)

(State)

(Zip)

Table I - Non-Derivative Securities Beneficially Owned

1. Title of Security (Instr. 4)

2. Amount of Securities

3. Ownership

4. Nature of Indirect Beneficial Ownership

Beneficially Owned (Instr. 4)

Form: Direct (D)

(Instr. 5)

or Indirect (I)

(Instr. 5)

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

3. Title and Amount of Securities

4.

5.

6. Nature of Indirect

Expiration Date

Underlying Derivative Security (Instr. 4)

Conversion

Ownership

Beneficial Ownership

(Month/Day/Year)

or Exercise

Form:

(Instr. 5)

Price of

Direct (D)

Amount

Derivative

or Indirect

or

Security

(I) (Instr. 5)

Number

Date

Expiration

of

Exercisable

Date

Title

Shares

Explanation of Responses:

Remarks:

EXHIBIT LIST: EX-24 Power of Attorney for: /s/ Noelle Matteson, Attorney-in-Fact for Raul J. Fernandez

No securities are beneficially owned.

/s/ Noelle Matteson, Attorney-

01/14/2020

in-Fact for Raul J. Fernandez

** 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.

POWER OF ATTORNEY

Know all by these presents, that the undersigned hereby constitutes and appoints each of (i) the Chief Financial Officer of Broadcom Inc., a Delaware corporation (the "Company"), and who is currently Thomas H.

1. prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the U.S. Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other do
2. execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of the Company, and/or 10% holder of the Company's capital stock, Forms 3, 4, and 5 and any amend
3. do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments
4. take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the un The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any o This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities i IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 7th day of January, 2020.

/s/	Raul J. Fernandez
By:	Raul J. Fernandez