| Regimental number | 11/1374 |
| Address | c/o John Theobald, Kaponga |
| Marital status | Single |
| Next of kin | Father, John Theobald, Kaponga, Taranaki |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 6th Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board HMNZT 28 Tofua on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Sixth |