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refund for delayed ticket

Dear sir or madam,

I'm writing to ask refund of my ticket as you promised.

Actually I used your service at 20/12 and it was retarded 266min.
So I received a envelope to get refund from you.
Then, I tried to follow procedure for refund as written on envelope.
I had entered all of the information as requested and it seemed also to be recognize my information.
Because they showed my other information which I didn't put in.

However the confirmation button didn't work and it said to me " Une ou plusieurs données ne respectent pas le format habituellement utilisé.".
I couldn't understand because I had already entered my information in correct way as requested.

My detail Information for ticket is as below:

About voyage:
Reference number: SINGGA
Customer reference number: 0029090163270806447
No. e-ticket: 414998931
Depart: PARIS EST (20/12 at 07:35)
Arrive: STRASBOURG GARE(20/12 at 11:44)
Train No.: 1001

About customer:
Civilite: Mme
Surname: KANG
Firstname: Suhyun
Adress: Suhodol Kamycka CZU Dorm G426
Post number: 16521
City: Praha
Country: Czech Republic
Phone number: +420 773 873 212

About compensation:
Retarded time: +266min
Type of compensation: Bon voyage
amount of moneyL 35.0 EUR
Number of pepole: 1

If you need more information, please let me know.
I wanna solve this problem as soon as possible.

Thank you

Best Regards,
Suhyun Kang

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