Payment Claims Voucher
| Pcv No | 2026-06-032837 | Settle Date | June 09, 2026 |
| Insured Name | CHEVRON (CAMBODIA) CO., LTD AS OWNER AND/OR MR. LAO LY SOPHAT AS RETAILER F.T.R.R&I | Policy No | PL/PPI/CR7-0736 |
| Claims No | CL/PL/PPI/131-01 | ||
| No | Invoice No | Description | Exchange Rate | Amount |
|---|---|---|---|---|
| 1 | Payment For: THIRD PARTY PROPERTY DAMAGE | USD 352.00 | ||
| Pay To: MUT KEO | ||||
| Payment Status: Full Payment | ||||
| Cheque No: | ||||
| Total | USD 352.00 | |||
| Amount in Word | USD Three Hundred Fifty Two and Zero Cents Only |
| Reviewed & Appr. PPI | Signature | Name | Date |
|---|---|---|---|
| PREPARED BY | vichet | June 09, 2026 | |
| CHECKED BY AM | KUSORL | June 09, 2026 | |
| VERIFIED BY HOD | SOCHEAN | June 09, 2026 | |
| APPR BY PPI CEO | SALY SOULEVANN | June 09, 2026 |
| Review And Approved By Group : | CHAIRMAN & CEO | CFO |
| Account Code | Account Name | Debit | Credit | |
|---|---|---|---|---|
| 111012 | Claim Paid-Liabilities | 352.00 | ||
| 660020 | Amount due from/(TO)Reinsuranc | 264.00 | ||
| Claim Rec.Cam.Re- Liability | ||||
| 114012 | Claim Rec.Q.T Share- Liabilty | 264.00 | ||
| Claim Rec.Surplus TTY-Liabilit | ||||
| 660216 | ABA - Collection Acct | 352.00 | ||
| TOTAL | 616.00 | 616.00 | ||
Print By: vichet