Zambia

Clinical Trial Application	Zambia Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	Unknown
Tail Coverage	Unknown
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Legal representative details of the Zambia Sponsor (name, address, email, telephone number) • Hold Harmless and Claims Cut-Through Clause signed by Sponsor (to be provided separately by the carrier)

Clinical Trial Application	n/a
Mandated Coverage	Yes
Standard Limits	USD 2,000,000
Tail Coverage	12 months
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form • Local CRO/Legal Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address) o Legal Representative details of the Sponsor in UAE to include authenticated documents proving ownership e.g. complete T/L, Share Certificate, Share Register, MOA, AOA, Annual Report, Ownership Chart etc. The document must clearly show the ownership % or holding shares and if there is any entity in the ownership pattern who holds >25% shareholding, futher ownership docs are required until the natural person with owning or controlling interests of >25% are identified. o Completed KYC AML form