Mexico

Clinical Trial Application	Mexico Clinical Trial Quote Request
Mandated Coverage	Yes
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	THE PROCESS IN MEXICO 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. PLEASE PROVIDE THE FOLLOWING INFORMATION • Clinical Trial Quote Request • Protocol and Informed Consent Form in English and Spanish • Protocol Title in Spanish • The following documents to be provided by the Sponsor: (i) Copy ID of the legal representative of the Sponsor (this should be the same as the person completing the form) (ii) Proof of address of the sponsor (not older than 3 months) (iii) Document confirming the legal establishment of the sponsor ---> Legal representative details of the Sponsor in Mexico Note the Legal Representative will be responsible for providing the following documents: (i) Copy of the Memorandum of Association registered upon the Property & Commerce Public registry (ii) Copy of the Fiscal Identification Schedule (RFC) (iii) Copy of an Official Identification and Notary’s Testimony of the local CRO (iv) Copy of a Domicile Voucher

Clinical Trial Application	Ukraine Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	Limit per protocol = 10.000 USD x number of patients
Tail Coverage	3 years
Data Required to Quote	The process is SLOW. Please allow additional time for processing. Typically up to 3 weeks • Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Ukrainian • Certificate of Incorporation of Sponsor (for new Sponsors in Ukraine only) • Name and Title of Authorized Signatory who will countersign policy • Name of document which gives the Signatory the authorization to countersign the policy. (i.e. Charter, Power of Attorney, Resolution by the Board of Directors) - Ukraine requires payment and payment confirmation documentation PRIOR to release of certificate - No refund for policy cancellation - Original documents are not required to be delivered to the local CRO. Only require copy of the Certificate which is issued by the carrier once the premium has been received