| Regimental number | 10/2639 |
| Address | Patea |
| Marital status | Single |
| Next of kin | Father, A Haysom, Rohais, Guernsey, Channel Islands |
| Rank on embarkation | Lance Corporal |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 6th Reinforcements, Wellington Infantry Battalion |
| Embarkation details | Unit embarked from Wellington on board Willochra on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Infantry Batln/Sixth |