| Regimental number | 9/933 |
| Address | Clak Crac, Otama |
| Marital status | Single |
| Next of kin | Mother, Mrs Mary Agnes Henry, Waverley, Anderson's Bay, Dunedin |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 4th Reinforcements, Otago Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Waitomo on |
| Miscellaneous details | Nominal Roll Vol. 1: Otago Mounted Rifles/Fourth |