| Regimental number | 12/114 |
| Address | 15 Pitt Street, Auckland |
| Marital status | Single |
| Next of kin | Mrs Annie Gooch, 24 Lower Street, Desborough, Northamptonshire, England |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, 1st Infantry Brigade, Headquarters |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1 |