X0306 4 2018-11-02 1 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001757506 Kuang Zhong ROOM 3005 NANHU JIAHECHENG NO. 82 MINZU ROAD NANNING 530022 0 0 0 1 Former 10% Owner 0001757405 Zac & Cloud Holdings LTD ROOM 3005 NANHU JIAHECHENG NO. 82 MINZU ROAD NANNING 530022 0 0 0 1 Former 10% Owner Common Stock 2018-11-02 4 C 0 347491 A 347491 I Zac and Cloud Holdings Ltd. Common Stock 2018-11-02 4 C 0 349862 A 697353 I Zac and Cloud Holdings Ltd. Common Stock 2018-11-02 4 C 0 187500 A 884853 I Zac and Cloud Holdings Ltd. Series A Preferred Stock 2018-11-02 4 C 0 150000 0.00 D Common Stock 347491 0 I Zac and Cloud Holdings Ltd. Series B-1 Preferred Stock 2018-11-02 4 C 0 291551 0.00 D Common Stock 349862 0 I Zac and Cloud Holdings Ltd. Series B-2 Preferred Stock 2018-11-02 4 C 0 156250 0.00 D Common Stock 187500 0 I Zac and Cloud Holdings Ltd. Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018. Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series A preferred stock automatically converted into 2.31660 shares of the Issuer's common stock. The A preferred stock had no expiration date. The shares are held of record by Zac and Cloud Holdings Ltd. ("Cloud"). Zhong Kuang is the sole-shareholder of Cloud and has voting and dispositive power over the shares held by Cloud. Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series B-1 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-1 preferred stock had no expiration date. Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series B-2 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-2 preferred stock had no expiration date. /s/ Zhong Kuang, on behalf of Zac and Cloud Holdings Ltd. 2018-11-02 /s/ Zhong Kuang 2018-11-02