| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| INDOCHINA RESEARCH ( CAMBODIA) CO., LTD | CHC/PPI/C-1041 |
Full Payment | CL/CHC/PPI/21215 | CL/CHC/PPI/21215-01 |
OUT-PATIENT | Chea Sam An | 25.13 |