| Regimental number | 10566 |
| Occupation | Farm hand |
| Next of kin | Father, R E Church, 91 Bannister Street, Masterton |
| Rank on embarkation | Driver |
| Unit name | New Zealand Expeditionary Force, 12th Reinforcements (2nd Draft), New Zealand Field Artillery, Divisional Ammunition Column |
| Embarkation details | Unit embarked from Wellington on |
| Other details | Returning from Albany Medically Unfit |
| Sources | Nominal Roll Vol. 2: Roll 31, p. 12 |