| Regimental number | 9/800 |
| Address | Otago |
| Marital status | Single |
| Next of kin | John Matheson, Runholder, Hyde, Otago |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 3rd Reinforcements, Otago Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board Aparima on |
| Miscellaneous details | Nominal Roll Vol. 1: Otago Mounted Rifles/Third |