| Regimental number | 6504 |
| Occupation | Labourer |
| Address | Orange, New South Wales |
| Marital status | Single |
| Age at embarkation | 24 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/19/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |