X0306 4 2018-11-02 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001420106 Gilde Healthcare Holding B.V. NEWTONLAAN 91 3584 BP UTRECHT THE NETHERLANDS 0 0 1 0 0001757508 Gilde Healthcare IV Management B.V. NEWTONLAAN 91 3584 BP UTRECHT THE NETHERLANDS 0 0 1 0 0001756335 Cooperatieve Gilde Healthcare IV U.A. NEWTONLAAN 91 3584 BP UTRECHT THE NETHERLANDS 0 0 1 0 Common Stock 2018-11-02 4 C 0 2266666 A 2266666 I By Cooperatieve Gilde Healthcare IV U.A. Common Stock 2018-11-02 4 P 0 866666 15.00 A 3133332 I By Cooperatieve Gilde Healthcare IV U.A. Series C Preferred Stock 2018-11-02 4 C 0 1888888 0.00 D Common Stock 2266666 0 I By Cooperatieve Gilde Healthcare IV U.A. 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 C preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The Series C preferred stock had no expiration date. The shares are held directly by Cooperatieve Gilde Healthcare IV U.A. ("Gilde"). Geoff Pardo ("Pardo"), who is a member of the Issuer's board of directors, is a partner of Gilde. Gilde is managed IV Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of Pardo, Management and Holding may be deemed to have voting, investment and dispositive power with respect to these securities. Each of Pardo, Management and Holding disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein. /s/ Marc Perret, on behalf on Gilde Healthcare Holding B.V. 2018-11-02 /s/ Marc Perret, on behalf of Gilde Healthcare IV Management B.V. 2018-11-02 /s/ Marc Perret, on behalf of Cooperatieve Gilde Healthcare IV U.A. 2018-11-02