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	Taiwan Clinical Trial Quote Request
Mandated Coverage	Yes
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	Process is slow. Please allow 2-3 weeks for receipt of documents • Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Local CRO details in English (Contact Person Name, Address, Telephone Number and E-Mail Address) • Certificate of Incorporation of Sponsor • Please confirm with your CRO if they require the sites to be named. If so, please provide the Site List in English, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code - Payment is made directly by Sponsor to Carrier - No refund for policy cancellation