| Regimental number | 3/126a |
| Address | 109 Caledonian Road, Christchurch |
| Marital status | Single |
| Next of kin | Mrs F S A A'Court, 109 Caledonian Road, St Albans, 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 |