| Regimental number | 13/1067A |
| Address | Katikati |
| Marital status | Single |
| Next of kin | Father, R V Surtees, Stanford Mail Bag, Katikati |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 3rd Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Aparima on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Third |