| Regimental number | 11/1212 |
| Address | c/o Mrs Doig, 100 Cuba Street, Palmerston North |
| Marital status | Single |
| Next of kin | Mother, Mrs Mary Petersen, Eketahuna |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 5th Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Tahiti on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Fifth |