Haiti

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

Clinical Trial Application	Bangladesh Clinical Trial Quote Request
Mandated Coverage	Unknown
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Provide local CRO contact information (Name, address, email, telephone number) Bangladesh requires payment and wire payment confirmation PRIOR to release of documentation. No refund for policy cancellation.