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	Haiti Clinical Trial Quote Request
Mandated Coverage	n/a
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Local Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address) and NIF (Haitian Tax ID #) • No refund for policy cancellation