| Regimental number | 21083 |
| Rank on embarkation | Private |
| Unit name | Miscellaneous Embarkations, Samoan Relief |
| Embarkation details | Unit embarked from New Zealand on board SS Talune on |
| Other details | Ex 16th Reinforcements proceeding to Samoa for discharge |
| Sources | Nominal Rolls Vol. 4: Roll 82, p. 24 |