X0306 4 2018-11-02 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001387382 Petrovich John George 26 TECHNOLOGY DRIVE IRVINE CA 92618 1 0 0 1 Former 10% Owner Common Stock 2018-11-02 4 C 0 289576 A 1177576 I See footnote Common Stock 2018-11-02 4 C 0 925394 A 2102970 I See footnote Series A Preferred Stock 2018-11-02 4 C 0 125000 0.00 D Common Stock 289576 0 I See footnote Series B-1 Preferred Stock 2018-11-02 4 C 0 771161 0.00 D Common Stock 925394 0 I See footnote 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. These securities are held by The Alfred E. Mann Foundation for Scientific Research. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. 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. /s/ Michael V. Williamson, as Attorney-in-Fact for John George Petrovich 2018-11-02