| Regimental number | 3/210 |
| Address | 111 Oxford Street, South Dunedin |
| Marital status | Single |
| Next of kin | Mrs G F Jackson, 111 Oxford Street, South Dunedin |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Medals |
Croix de Guerre (Belgium) 'For distinguished services rendered during the course of the campaign.'
Source: 'London Gazette' Date: |
| Miscellaneous details | Nominal Roll Vol. 1: Medical Corps/Main Body |