| Regimental number | 58216 |
| Place of birth | Shellharbour New South Wales |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Bangalow, New South Wales |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Father, R Fuller, Bangalow, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 6th (Queensland) Reinforcements |
| AWM Embarkation Roll number | 23/111/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A41 Bakara on |