| Regimental number | 3/1012 |
| Address | 158 Tinakori Road, Wellington |
| Marital status | Single |
| Next of kin | Friend, Mrs A Beere, 158 Tinakori Road, Wellington |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 7th Reinforcements, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1: Medical Corps/Seventh |