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	Costa Rica Clinical Trial Quote Request
Mandated Coverage	Unknown. Please confirm with your CRO.
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol title in Spanish • Legal Representative in Costa Rica or Local CRO details (Contact Person Name, Address, Telephone Number and E-Mail Address) No refund for policy cancellation