| Regimental number | 23/75 |
| Address | Waimangaroa, Westport |
| Marital status | Single |
| Next of kin | Mother, Mrs Janet Bloom, Abbotsford, Melbourne, Victoria, Australia |
| Rank on embarkation | Rifleman |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 1st Battalion, New Zealand Rifle Brigade, A Company |
| Embarkation details | Unit embarked from Wellington on board Maunganui on |
| Miscellaneous details | Nominal Roll Vol. 1: A Company/1st NZRB |