| Clinical Trial Application | Indonesia Clinical Trial Quote Request |
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| Mandated Coverage | |
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| Standard Limits | |
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| Tail Coverage | |
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| Data Required to Quote | • Clinical Trial Quote Request
• Protocol and Informed Consent Form in English
• Site List in English, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code
• Local Representative/CRO details (Contact Person Name, Address, Telephone Number and E-Mail Address)
- Premium payment and payment confirmation required PRIOR to release of certificate
- No refund for policy cancellation
Please allow additional time for processing |
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