| Regimental number | 72941 |
| Occupation | Yardman |
| Next of kin | Mother, Mrs Amelia Jack, Fox Street, Cobden, Greymouth |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 38th Reinforcements, A Company |
| Embarkation details | Unit embarked from New Zealand on board HMNZT No 105 Remuera on |
| Sources | Nominal Rolls Vol. 4: Roll 83, p. 5 |