X0306 4 2018-11-02 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001380178 Malik Shahzad 26 TECHNOLOGY DRIVE IRVINE CA 92618 1 0 0 1 Former 10% Owner Common Stock 2018-11-02 4 C 0 43822 A 43822 I By Advent Life Sciences LLP Common Stock 2018-11-02 4 C 0 1231178 A 1275000 I By Advent Life Sciences Fund II LP Common Stock 2018-11-02 4 C 0 14412 A 1289412 I By Advent Life Sciences LLP Common Stock 2018-11-02 4 C 0 404937 A 1694349 I By Advent Life Sciences Fund II LP Series B-2 Preferred Stock 2018-11-02 4 C 0 36518 0.00 D Common Stock 43822 0 I By Advent Life Sciences LLP Series B-2 Preferred Stock 2018-11-02 4 C 0 1025981 0.00 D Common Stock 1231178 0 I By Advent Life Sciences Fund II LP Series C Preferred Stock 2018-11-02 4 C 0 12010 0.00 D Common Stock 14412 0 I By Advent Life Sciences LLP Series C Preferred Stock 2018-11-02 4 C 0 337447 0.00 D Common Stock 404937 0 I By Advent Life Sciences Fund II LP 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 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. Securities are held by Advent Life Sciences LLP ("Advent"). The reporting person, who is a member of the Issuer's board of directors, is a general partner of Advent, and disclaims beneficial ownership of the shares held by Advent except to the extent of his indirect pecuniary interest therein. Securities are held by Advent Life Sciences Fund II LP. Advent is the general partner of Advent Life Sciences Fund II LP and the reporting person, who is a member of the Issuer's board of directors, is a partner of Advent. The reporting person disclaims beneficial ownership of the shares held by Advent Life Sciences Fund II LP except to the extent of his respective indirect pecuniary interest therein. 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 C preferred stock had no expiration date. /s/ Michael V. Williamson, as Attorney-in-Fact for Shahzad Malik 2018-11-02