| Regimental number | 12289 |
| Occupation | Drainer |
| Next of kin | Mother, Mrs W M Tate, Osborne Street, Newmarket, Auckland |
| Rank on embarkation | Rifleman |
| Unit name | New Zealand Expeditionary Force, New Zealand Rifle Brigade, 3rd Reinforcements to 3rd Battalion, G Company |
| Embarkation details | Unit embarked from Wellington on |
| Other details | Returning from Albany Medically unfit |
| Sources | Nominal Roll Vol. 2: Roll 31, p. 22 |