| Regimental number | 22037 |
| Occupation | Baker |
| Next of kin | Mother, Mrs A Jacobs, Market Street, Dunedin |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 16th Reinforcements, Otago Infantry Battalion, D Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 63 Navua on |
| Sources | Nominal Roll Vol. 2: Roll 38, p. 17 |