Uganda

Clinical Trial Application	Uganda Clinical Trial Quote Request Clinical Trials 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 • Legal Representative details of Sponsor ((Contact Person Name, Address, Telephone Number and E-Mail Address) • Completed Know Your Customer (KYC) Form and Proposal Form to be provided separately • Premium payment is due in advance of release of policy documents No refund for policy cancellation

Clinical Trial Application	Belgium Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	Between 400.000 and 600.000 €/patient Between 3.000.000 and 5.000.000 €/protocol
Tail Coverage	3 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in French • Local EU Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address). Not required if Sponsor is domiciled in the EU.