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"

Clinical Trial Application	Moldova Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	Between 5.000 and 10.000 €/patient Limit per protocol = limit per patient x number of patients
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • No refund for policy cancellation