| Regimental number | 1/417 |
| Address | 15 Manners Street, Wellington |
| Marital status | Single |
| Next of kin | F Kitto, 15 Manners Street, Wellington |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, New Zealand Rifle Brigade, 12th Reinforcements to 2nd Battalion, F Company |
| Embarkation details | Unit embarked from Wellington on board Willochra on |
| Miscellaneous details | Nominal Roll Vol. 1: 5th (Wellington) Regiment/Samoan Adv |