| Regimental number | 10/1128 |
| Address | Grassmere, Invercargill |
| Marital status | Single |
| Next of kin | Mrs W H Broad, Grassmere, Invercargill |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1 |