| Regimental number | 23/916 |
| Address | c/o Mrs Black, Paeroa |
| Marital status | Single |
| Next of kin | Mother, Mrs A Stemson-Merritt, Whakatane |
| Rank on embarkation | Rifleman |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 1st Battalion, New Zealand Rifle Brigade, C Company |
| Embarkation details | Unit embarked from Wellington on board Mauganui on |
| Miscellaneous details | Nominal Roll Vol. 1: C Company/1st NZRB |