| Regimental number | 19/334 |
| Address | 109 Britomart Street, Berhampore, Wellington |
| Marital status | Single |
| Next of kin | Father, Captain W H Martyn Roberts, New Zealand Staff Corps, Masterton |
| 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 |