| Regimental number | 3/104A |
| Address | Harewood Road, Papanui, Christchurch |
| Marital status | Single |
| Next of kin | Mrs Rosa Clara Yates, 206 Harewood Road, Papanui, Christchurch |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, Ambulance |
| Embarkation details | Unit embarked from Wellington on board Star of India on |
| Miscellaneous details | Nominal Roll Vol. 1: Ambulance/Main Body |