Georgia

Georgia Clinical Trial Quote Request

Yes

Usually 2.000.000 €/protocol
No deductible

1 year

THE PROCESS IN GEORGIA IS SLOW. PLEASE ALLOW ONE MONTH FOR
DOCUMENTS TO BE PROCESSED. Please provide all documentation outlined below otherwise the process is further delayed.

• Clinical Trial Quote Request
• Protocol and Informed Consent Form in English
• Protocol Title in Georgian
• Site List in Georgian and English, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code
• Certificate of Incorporation of Sponsor
• CEO/Director details of Sponsor, together with Copy of Identification of CEO/Director of Sponsor (typically Drivers License or Passport)
• Sponsor to provide Local CRO contact details (Contact Person Name, Address, Telephone Number and E-Mail Address)

Due to the tightening of money laundering regulations, 25+% shareholders must be declared and the following provided:
1. For entities: Certificate of Incorporation and copy of Identification for all shareholders owning more than 25%
2. For individuals: copy of Identification for each shareholder owning more than 25%
3. Completed "Ultimate Beneficial Owners" (UBO) application. ABD to provide separately
4. Completed "Know Your Customer" (KYC) questionnaire. ABD to provide separately

NOTE: Georgia requires payment and wire payment confirmation details PRIOR to release of policy documentation

- No refund for policy cancellation
- Please note that Original Policy and Certificate documents are NOT a requirement in Georgia if there is no premium associated with the documents. If there is premium owed, then wet-inked originals are required by the carrier
- Sponsor to confirm with their local CRO and advise how many Originals are required for this study
- Sponsor first signs the Originals and then sends to the carrier
- Carrier sends countersigned wet-inked Originals directly to local CRO in Georgia once received from Sponsor

Dominican Republic Clinical Trial Quote Request

Dominican Republic Due Diligence Form - Spanish (Persona Juridica)

Yes and No. Clinical Trial Insurance is not compulsory, however, it is made mandatory as part of the MoH submission.

n/a

n/a

• 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