| Regimental number | 3563A |
| Religion | Church of England |
| Occupation | Fireman |
| Address | Ship's Street, Port Adelaide, South Australia |
| Marital status | Married |
| Age at embarkation | 29 |
| Next of kin | Wife, Mrs R E Fulcher, Ship's Street, Port Adelaide, South Australia |
| Enlistment date | 21 January 1916 |
| Rank on enlistment | Sapper |
| Unit name | No 1 Mining Corps, 4th Reinforcements |
| AWM Embarkation Roll number | 16/8/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Orontes on 16 August 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
