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	Guatemala Clinical Trial Quote Request Guatemala IVE Formulario
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 and Spanish • Protocol Title in Spanish • Local Legal Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address) • Guatemala IVE Formulario must be completed by a Guatemalan entity/local legal representative • No refund for policy cancellation