| Regimental number | 61004 |
| Occupation | Labourer |
| Next of kin | Wife, Mrs C A Terry, 4 John Street, Sydenham, Christchurch |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 30th Reinforcements, Canterbury Infantry Regiment, C Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT No 93 Corinthic on |
| Sources | Nominal Roll Vol. 3: Roll 72, p. 13 |