| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| UPPER ROOM CITY FELLOWSHIP INTERNATIONAL | PA/PPI/C-48752 |
Full Payment | CL/PA/PPI/3975 | CL/PA/PPI/3975-01 |
ACCIDENTAL MEDICAL EXPENSE | MURILLO SUBRABAS LILY G | 90.96 |
| Account Code | Account Name | Debit | Credit |
|---|---|---|---|
111006 |
Claim Paid - PA | 90.96 | 0.00 |
660020 |
Amount due from/(TO)Reinsuranc | 72.77 | 0.00 |
115506 |
Claim Rec.Cam.Re- P.A | 0.00 | 18.19 |
114006 |
Claim Rec.Q.T Share- P.A | 0.00 | 54.58 |
660216 |
ABA - Collection Acct | 0.00 | 90.96 |