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*
Paz Ramon

(Last) (First) (Middle)
C/O HEARTWARE, INC.
3351 EXECUTIVE WAY

(Street)
MIRAMAR FL 33025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/02/2007
3. Issuer Name and Ticker or Trading Symbol
HeartWare LTD [ ASX:HTW ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Vice President, Quality Assur.
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 15,000 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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Option to Purchase (1) 01/31/2015 Ordinary Shares 10,000 $0.15(2) D
Option to Purchase (3) 07/25/2006 Ordinary Shares 220,000 $0.83(4) D
Explanation of Responses:
1. The option is exercisable in four equal installments on January 31,2006, 2007, 2008 and 2009, respectively.
2. The exercise price of US$0.15 has been converted from AU$0.20 at the spot rate on the date of grant.
3. The option is exercisable in four equal installments on July 25,2007, 2008, 2009 and 2010, respectively.
4. The exercise price of US$0.83 has been converted from AU$1.10 at the spot rate on the date of grant.
Remarks:
/s/ Ramon Paz 11/21/2007
** 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.