| Regimental number | 4730 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | c/o Mrs J Gibson, Derwent Park Farm, Home Hill, Burdekin, Queensland |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs Catherine Green, 1A Church Street, Clapham Road, Brixton, London, England |
| Enlistment date | 5 January 1916 |
| Date of enlistment from Nominal Roll | 1 November 1915 |
| Rank on enlistment | Private |
| Unit name | 26th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/43/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Mooltan on 12 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 26th Battalion |
| Fate | Returned to Australia 14 January 1917 |
