Maisha Air Ambulance Cover

Create New Maisha Account

Please complete the form below to create a new account. This account will allow you to activate and manage your Maisha Covers. Your Email Address will be your Login ID. Please Note: All fields are required.

First Name

Last Name

Email Address (Login ID)

Telephone / Mobile Number

ID / Passport

Date of Birth

Address

Postal Code

Town

Country

Password Should contain atleast one uppercase letter and one number

Confirm your Password

Age Verification
I Agree that I'm 18 years and above

I am not a Robot
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