| Regimental number | 11/1303 |
| Address | 16 Buller Street, Wellington |
| Marital status | Single |
| Next of kin | Father, J Clark, The Grange, Humberstone Avenue, Grimsby, Lincoln, England |
| Rank on embarkation | Trooper |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 6th Reinforcements, Wellington Mounted Rifles |
| Embarkation details | Unit embarked from Wellington on board HMNZT 28 Tofua on |
| Miscellaneous details | Nominal Roll Vol. 1: Wellington Mounted Rifles/Sixth |