Costa Rica

Clinical Trial Application	Costa Rica Clinical Trial Quote Request
Mandated Coverage	Unknown. Please confirm with your CRO.
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol title in Spanish • Legal Representative in Costa Rica or Local CRO details (Contact Person Name, Address, Telephone Number and E-Mail Address) No refund for policy cancellation

Clinical Trial Application	India Specific Clinical Trial Quote Request
Mandated Coverage	Yes
Standard Limits	From 1 to 5 Million USD in aggregate
Tail Coverage	6 months (up to 1 year available for an additional premium)
Data Required to Quote	• Country-specific Application and Application must be printed and signed PRIOR to binding coverage • Protocol and Informed Consent Form in English • A local entity must be named as the Policyholder (Investigator or CRO) - No refund for policy cancellation - India requires payment to the carrier PRIOR to release of certificate To bind coverage: • provide Permanent Account Number (PAN) of the Local CRO. PAN number is a ten-digit alphanumeric number, issued in the form of a laminated card by the Income Tax Department • provide Good and Services Tax (GST) number of the Local CRO Please allow additional time for processing. Please allow at least one month before issuance of policy documents