| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| WORLD VISION INTERNATIONAL | CHC/PPI/CR2-1027 |
Full Payment | CL/CHC/PPI/20862 | CL/CHC/PPI/20862-01 |
OUT-PATIENT | HEAP PHEAROM AND PICH KEOPISETH AND TANG FUNSANG | 113.70 |