Multinational Clinical Trial Renew/Revise Form

For your US produced Chubb Multinational program, use the below form to request a clinical trials certificate by providing the relevant information.

If you have any questions, please reach out to your Chubb service coordinator, or email: ClinicalTrialsCerts@Chubb.com

Insured Name

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Country

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Protocol Number

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Requestor Name

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Requestor Email

This is required field

Reason for Renewal / Revision

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Comments

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If you are a California resident, please read our Notice at Collection.