| Regimental number | 10840 |
| Occupation | Prospector |
| Next of kin | Wife, Mrs K M Jacobson, 24 Bridge Street, Nelson |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 12th Reinforcements (2nd Draft), 1st New Zealand Cyclist Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 52 Mokoia on |
| Sources | Nominal Roll Vol. 2: Roll 31, p. 5 |