| 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/21221 | CL/CHC/PPI/21221-01 |
OUT-PATIENT | Soy Bunthoeurt | 39.68 |