| Regimental number | 19/21 |
| Address | Granity, Westport |
| Marital status | Married |
| Next of kin | Wife, Mrs G B Bougen, Granity, Westport |
| 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 |