Indonesia

Clinical Trial Application	Indonesia Clinical Trial Quote Request
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 • 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