| Regimental number | 11/1176 |
| Address | 52 Collins Street, Hawera |
| Marital status | Single |
| Next of kin | James Lash, 52 Collins Street, Hawera |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 4th Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Waitomo on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Fourth |