Payment Claims Voucher
| Pcv No | 2026-06-032743 | Settle Date | June 02, 2026 |
| Insured Name | INTERNATIONAL JUSTICE MISSION (IJM) | Policy No | PA/PPI/CR1-48482 |
| Claims No | CL/PA/PPI/3851-02 | ||
| No | Invoice No | Description | Exchange Rate | Amount |
|---|---|---|---|---|
| 1 | Payment For: ACCIDENTAL MEDICAL EXPENSE | USD 43.14 | ||
| Pay To: Khema Global Co.,Ltd | ||||
| Payment Status: Partial Payment | ||||
| Cheque No: | ||||
| Total | USD 43.14 | |||
| Amount in Word | USD Forty Three and Fourteen Cents Only |
| Reviewed & Appr. PPI | Signature | Name | Date |
|---|---|---|---|
| PREPARED BY | kosal | June 02, 2026 | |
| CHECKED BY AM | KUSORL | June 02, 2026 | |
| VERIFIED BY HOD | SOCHEAN | June 02, 2026 | |
| APPR BY PPI CEO | SALY SOULEVANN | June 02, 2026 |
| Review And Approved By Group : | CHAIRMAN & CEO | CFO |
| Account Code | Account Name | Debit | Credit | |
|---|---|---|---|---|
| 111006 | Claim Paid - PA | 43.14 | ||
| 660020 | Amount due from/(TO)Reinsuranc | 34.51 | ||
| 115506 | Claim Rec.Cam.Re- P.A | 8.63 | ||
| 114006 | Claim Rec.Q.T Share- P.A | 25.88 | ||
| 660215 | FTB-Claims Acc. | 43.14 | ||
| TOTAL | 77.65 | 77.65 | ||
Print By: kosal