| Regimental number | 19/208 |
| Address | c/o Dr Orchard, Christchurch |
| Marital status | W |
| Next of kin | Daughter, Miss Stella Maud Orchard, c/o Dr Orchard, Christchurch |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | Samoan Relief Force, Infantry |
| Embarkation details | Unit embarked from Auckland on board SS Talune on |
| Miscellaneous details | Nominal Roll Vol. 1: Infantry/Samoan Relief |