| Regimental number | 3/109 |
| Address | Sale Street, Napier |
| Marital status | Single |
| Next of kin | Mother, Mrs Ada Grant, 13 Sale Street, Napier |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1 |