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	Tanzania Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	THE PROCESS IN TANZANIA IS SLOW. PLEASE ALLOW UP TO TWO MONTHS 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 • Certificate of Incorporation of Sponsor • Sponsor Business License • Tax Identification Number (TIN) number (FEIN will suffice) - Premium payment required in advance of receipt of policy documents - No refund for policy cancellation