State Bank Of India [SBI] — sail mediclaim not able to pay via sbi collect

Address: 560100

When i try to pay sail mediclaim via sbi collect under after entering min number an error is thrown saying "please verify the data entered and try again". Error is throwing.

The following steps i did for the payment.
Go to www.onlinesbi.com and click on the ‘state bank collect’ tab on the menu bar. Select ‘new version’.
Next page, click the box ‘i have read and accepted the terms …’ and click on the proceed button
Next page – first select ‘national capital territory of delhi’ from drop-down menu under ‘state of corporate/institution’ and then select ‘industry’ under ‘type of corporate/institution’ and then click the go button
Next page – select ‘steel authority of india limited’ under industry name and then click submit
Next page – select either ‘mediclaim self/ mediclaim spouse / mediclaim both’, from the drop-down menu, depending on your case
After selecting ‘mediclaim both’ option, i entered the min of ex-employee and min of the spouse.
On clicking ‘submit’, i am getting this error.
Please do the needful.