| Regimental number | 6/4124 |
| Occupation | Labourer |
| Next of kin | Brother, E B Petersen, 34 Parkes Street, Christchurch |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 10th Reinforcements, Canterbury Infantry Regiment, C Company |
| Embarkation details | Unit embarked from Wellington on board Willochra on |
| Sources | Nominal Roll Vol. 2: Roll 26, p. 15 |