| Regimental number | 9/1234 |
| Address | High Street, Dunedin |
| Marital status | Single |
| Next of kin | Friend, Miss Edna Allen, Kia Ora Tea Rooms, Dunedin |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Otago Mounted Rifles Regiment, 6th Reinforcement |
| Embarkation details | Unit embarked from Wellington on board HMNZT 28 Tofua on |
| Miscellaneous details | Nominal Roll Vol. 1: Otago Mounted Rifles/Sixth |