| Regimental number | 5004 |
| Place of birth | Sydney New South Wales |
| Religion | Roman Catholic |
| Occupation | Packer |
| Address | 130 Wells Street, Redfern, New South Wales |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs T Harris, 130 Wells Street, Redfern, New South Wales |
| Previous military service | 19th Infantry |
| Enlistment date | 30 October 1915 |
| Rank on enlistment | Private |
| Unit name | 19th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/36/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A31 Ajana on 5 July 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 36th Battalion |
| Fate | Returned to Australia 12 May 1918 |
