Czech Republic

Clinical Trial Application	Czech Republic Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	No statutory limits specified by law. Typical limits are USD 1M or EUR 500,000 per trial or in the aggregate. These limits are subject to change.
Tail Coverage	Between 1 and 3 years (depends upon the carrier)
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Czech • Provide EudraCT Number for Drug studies or EUDAMED No. for Medical Device studies, if not already included in Protocol

Clinical Trial Application	Dominican Republic Clinical Trial Quote Request Dominican Republic Due Diligence Form - Spanish (Persona Juridica)
Mandated Coverage	Yes and No. Clinical Trial Insurance is not compulsory, however, it is made mandatory as part of the MoH submission.
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 Dominican Republic or Local CRO details (Contact Person Name, Address, Telephone Number and E-Mail Address) • No refund for policy cancellation Due to strict Anti-Money Laundering laws, the Legal Representative (typically your local CRO) will be responsible for providing the following documents: (i) Due Diligence Form, available in Spanish only (to be completed by US Sponsor and each named insured, including additional insureds) (ii) Fiscal ID certificate (iii) Mercantile Registry (iv) ID of the person acting on behalf of the Legal Representative (v) Certificate of final beneficiary Process in the Dominican Republic is SLOW, so please allow for additional time - minimum 1 month before receipt of documentation after binding coverage