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	Lithuania Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	About 30.000 €/patient Limit per protocol = 100.000 x the number of patients
Tail Coverage	5 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English