| Regimental number | 647 |
| Place of birth | Penshurst Victoria |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Dickens Street, Penshurst, |
| Marital status | SA |
| Age at embarkation | 30 |
| Next of kin | Mother, Mrs Mary Green, Dickens Street, Penshurst, |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 13th Light Horse Regiment, 1st Reinforcement |
| AWM Embarkation Roll number | 10/18/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 57th Battalion |
| Recommendations (Medals and Awards) |
Unspecified Recommendation date: |
| Fate | Returned to Australia |