| Regimental number | 1/015 |
| Address | 24 Hill Street, Wellington |
| Marital status | Single |
| Next of kin | Mrs Jones, |
| Rank on embarkation | Sergeant |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 17th Reinforcements, Otago Infantry Battalion, D Company |
| Embarkation details | Unit embarked from Wellington on board Pakeha on |
| Miscellaneous details | Nominal Roll Vol. 1: 5th Wellington Regiment/Samoan Adv |