| Regimental number | 11/891 |
| Address | c/o A L Williams, Levin |
| Marital status | Single |
| Next of kin | Father, W Jackson, Biggerswade, Bedfordshire, England |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 4th Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Waitomo on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Fourth |