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	Portugal Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	100.000 €/patient 2 to 5.000.000 €/protocol
Tail Coverage	2 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Portuguese • Tax Identification Number (TIN) of the sponsor • Site List in Portuguese, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code