| Insured Name |
Policy No |
Payment Status |
Claim No |
Transaction No |
In Payment Of |
Payee Name |
Summary Amount |
| THY VANTHOEUN |
PA/PPI/C-48368 |
Full Payment
|
CL/PA/PPI/3932 |
CL/PA/PPI/3932-01 |
ACCIDENTAL MEDICAL EXPENSE |
HEANG HAY |
15.00 |
| Payment Merge |
Paid Amount |
Payee Name |
Payment For |
Amount in Word |
Payment ID |
|
|
|
|
|
|
| Account Code |
Account Name |
Debit |
Credit |
111006 |
Claim Paid - PA |
15.00 |
0.00 |
660020 |
Amount due from/(TO)Reinsuranc |
12.00 |
0.00 |
115506 |
Claim Rec.Cam.Re- P.A |
0.00 |
3.00 |
114006 |
Claim Rec.Q.T Share- P.A |
0.00 |
9.00 |
660216 |
ABA - Collection Acct |
0.00 |
15.00 |