| Regimental number | 21764 |
| Occupation | Shepherd |
| Next of kin | Mother, Mrs Margaret Anniss, Burkes Pass Fairlie South Canterbury |
| Rank on embarkation | Rifleman |
| Unit name | New Zealand Expeditionary Force, New Zealand Rifle Brigade, 7th Reinforcements to 3rd Battalion, G Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 62 Mokoia on |
| Sources | Nominal Roll Vol. 2: Roll 38, p. 34 |