Payment Claims Voucher
| Pcv No | 2026-06-032794 | Settle Date | June 05, 2026 |
| Insured Name | CHEVRON (CAMBODIA) CO., LTD AS OWNER AND KONGKEA CENTURY PLAZA PETROL STATION AS RETAILER F.T.R.R&I | Policy No | PL/PPI/CR3-0784 |
| Claims No | CL/PL/PPI/129-01 | ||
| No | Invoice No | Description | Exchange Rate | Amount |
|---|---|---|---|---|
| 1 | Payment For: THIRD PARTY PROPERTY DAMAGE | USD 107.40 | ||
| Pay To: SIM KONGKEA | ||||
| Payment Status: Full Payment | ||||
| Cheque No: | ||||
| Total | USD 107.40 | |||
| Amount in Word | USD One Hundred Seven and Forty Cents Only |
| Reviewed & Appr. PPI | Signature | Name | Date |
|---|---|---|---|
| PREPARED BY | kosal | June 05, 2026 | |
| CHECKED BY AM | KUSORL | June 05, 2026 | |
| VERIFIED BY HOD | SOCHEAN | June 05, 2026 | |
| APPR BY PPI CEO | SALY SOULEVANN | June 05, 2026 |
| Review And Approved By Group : | CHAIRMAN & CEO | CFO |
| Account Code | Account Name | Debit | Credit | |
|---|---|---|---|---|
| 111012 | Claim Paid-Liabilities | 107.40 | ||
| 660020 | Amount due from/(TO)Reinsuranc | 80.55 | ||
| Claim Rec.Cam.Re- Liability | ||||
| 114012 | Claim Rec.Q.T Share- Liabilty | 80.55 | ||
| Claim Rec.Surplus TTY-Liabilit | ||||
| 660216 | ABA - Collection Acct | 107.40 | ||
| TOTAL | 187.95 | 187.95 | ||
Print By: kosal