| Regimental number | 4209 |
| Place of birth | Burra South Australia |
| Religion | Church of England |
| Occupation | Striker |
| Address | 35 Seventh Avenue, Maylands, Western Australia |
| Marital status | Married |
| Age at embarkation | 29 |
| Next of kin | Wife, Mrs M E V Gray, 35 Seventh Avenue, Maylands, Western Australia |
| Enlistment date | 23 September 1915 |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/28/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A30 Borda on 17 January 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
