| Regimental number | 57689 |
| Place of birth | Clermont Queensland |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Pitt Street, North Bundaberg, Queensland |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, T Ford, Pitt Street, North Bundaberg, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Queensland Reinforcement 4 |
| AWM Embarkation Roll number | 23/111/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Orontes on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Broad Guage Railway Operating Company |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in Queensland Garden of Remembrance |
| Date of death |