| Regimental number | 3/2622 |
| Occupation | Clerk |
| Next of kin | Wife, Mrs Doris M Mackisack, c/o Mrs G Blythe, 12 Albert Street, St Clair, Dunedin |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 20th Reinforcements, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on 30 December 1916 |
| The Medical Corps component of the 20th Reinforcements left New Zealand on board two ships, HMNZT 72 'Athenic' and HMNZT 73 'Opawa'. It is not possible from the Nominal Roll to determine on which ship an individual embarked. |
| Sources | Nominal Roll Vol. 2: Roll 49, p. 21 |
