| Regimental number | 17004 |
| Place of birth | Ipswich Queensland |
| Religion | Congregational |
| Occupation | Clerk |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Mother, Mrs L Hancock, Fairy Knoll, Ipswich, Queensland |
| Enlistment date | 8 January 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps February 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A16 Port Melbourne on 16 July 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Field Ambulance |
| Fate | Returned to Australia 19 June 1919 |
