Payment Request
PAYEE | LIFE INSURANCE COMPANY OF NORTH AMERICA |
---|---|
EXPENSE CATEGORY | LONG-TERM DISABILITY PREMIUMS |
DEPARTMENT | HUMAN RESOURCES |
FUND | EMPLOYEE BENEFITS FUND |
PROGRAM | OPTIONAL COVERAGE PAID BY EMPLOYEE |
ACTIVITY | OPTIONAL COVERAGE PAID BY EMPLOYEE | PAYMENT REQUEST | PRM 5800 21101801604 |
PURCHASE ORDER | CONTRACT | DESCRIPTION | REF. LINE | CHECK DATE | CHECK STATUS | AMOUNT |
---|---|---|---|---|---|---|
DO 5800 21101301028 | n/a | Disability Insurance | 112 | 10/19/2021 | Paid | $158,674.12 |