Guatemala

Clinical Trial Application	Guatemala Clinical Trial Quote Request Guatemala IVE Formulario
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 and Spanish • Protocol Title in Spanish • Local Legal Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address) • Guatemala IVE Formulario must be completed by a Guatemalan entity/local legal representative • No refund for policy cancellation

Clinical Trial Application	n/a
Mandated Coverage	Yes
Standard Limits	USD 2,000,000
Tail Coverage	12 months
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form • Local CRO/Legal Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address) o Legal Representative details of the Sponsor in UAE to include authenticated documents proving ownership e.g. complete T/L, Share Certificate, Share Register, MOA, AOA, Annual Report, Ownership Chart etc. The document must clearly show the ownership % or holding shares and if there is any entity in the ownership pattern who holds >25% shareholding, futher ownership docs are required until the natural person with owning or controlling interests of >25% are identified. o Completed KYC AML form