| Name | Birth Year | Birth Place |
| Lawrence Burgis | 1892 | Leamington, Warwickshire, England |
| Lorna Burgis | 1888 | Davos, Switzerland |
| Beatrice Lewin | 1894 | Greenwich, London, England |
| Emily Sampson | 1887 | Caterham, Surrey, England |
| Address | Unknown 4 |
| Parish | Warlingham |
| Registration District | Godstone |
| County | Surrey |
Source: findmypast - 1921 Census