| Regimental number | 4436 |
| Place of birth | Cooma, New South Wales |
| Religion | Church of England |
| Occupation | Bank clerk |
| Address | Goulburn, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Father, William H Haxby, Commercial Bank, Windsor, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 1st Pioneer Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 14/13/5 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A29 Suevic on |