| Regimental number | 3619 |
| Religion | Church of England |
| Occupation | Mariner |
| Address | Hobart, Tasmania |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, T Fazackerley, Tyenna, Tasmania |
| Previous military service | 93rd Infantry |
| Enlistment date | 17 September 1917 |
| Rank on enlistment | Private |
| Unit name | 40th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/57/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A60 Aeneas on 30 October 1917 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
