| Regimental number | 75961 |
| Occupation | Painter |
| Next of kin | Wife, Mrs M A Jorgensen, 116 Derby Street Westport |
| Rank on embarkation | Gunner |
| Unit name | New Zealand Expeditionary Force, 43rd Reinforcements (2nd Draft), New Zealand Field Artillery |
| Embarkation details | Unit embarked from Wellington on board HMNZT 111 Matatua on |
| Sources | Nominal Rolls Vol. 4: Roll 90, p. 19 |