| Regimental number | 21972 |
| Occupation | Striker |
| Next of kin | Father, George Burt, 45 Helena Street, South Dunedin |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 16th Reinforcements, Otago Infantry Battalion, D Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 63 Navua on |
| Sources | Nominal Roll Vol. 2: Roll 38, p. 16 |