| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| KONG SODANY | CHC/PPI/C-1057 |
Full Payment | CL/CHC/PPI/21192 | CL/CHC/PPI/21192-01 |
OUT-PATIENT | Chea Sam An | 44.46 |