Ecuador

Ecuador

Ecuador

Ecuador

Clinical Trial Application

Ecuador Clinical Trial Quote Request

Ecuador Know Your Customer Form

Mandated Coverage

Yes

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
• Local Legal Representative/CRO details (Contact Person Name, Telephone Number and E-mail Address) and RUC number (Ecuadorian Tax ID)
• No refund for policy cancellation

- CRO or Local Legal Representative must provide the completed "Know Your Customer Form"

Luxembourg

Luxembourg

Clinical Trial Application

Luxembourg Clinical Trial Quote Request

Clinical Trials Quote Request

Mandated Coverage

Yes

Standard Limits

Between 400 and 500.000 €/patient
Between 3M and 5M €/protocol

Tail Coverage

3 years

Data Required to Quote

• Clinical Trial Quote Request
• Protocol and Informed Consent Form in English
• Protocol Title in French
• Site List in English, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code
• Local EU Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address)