| Regimental number | 65512 |
| Occupation | Labourer |
| Next of kin | Mother, Mrs Cecila Burgess, 9 Point Hill, Greenwich, London SE, England |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 33rd Reinforcements, Canterbury Infantry Regiment, C Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 99 Athenic on |
| Sources | Nominal Roll Vol. 3: Roll 76, p. 10 |