Ukraine

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

Clinical Trial Application	Czech Republic Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	No statutory limits specified by law. Typical limits are USD 1M or EUR 500,000 per trial or in the aggregate. These limits are subject to change.
Tail Coverage	Between 1 and 3 years (depends upon the carrier)
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Czech • Provide EudraCT Number for Drug studies or EUDAMED No. for Medical Device studies, if not already included in Protocol