| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| MENGLY J. QUACH EDUCATION PLC. | PA/PPI/C-48472 |
Full Payment | CL/PA/PPI/3977 | CL/PA/PPI/3977-01 |
ACCIDENTAL MEDICAL EXPENSE | MENGLY J. QUACH EDUCATION PLC | 24.80 |