| Regimental number | 2107 |
| Place of birth | West Tamworth New South Wales |
| Religion | Church of England |
| Occupation | Carter |
| Address | West Tamworth, New South Wales |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Mother, Mrs Susan Hayne, Deane Street, West Tamworth, New South Wales |
| Enlistment date | 20 November 1916 |
| Rank on enlistment | Private |
| Unit name | December 1916 Reinforcements |
| AWM Embarkation Roll number | 11/14/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Karmala on 3 February 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Field Ambulance |
| Fate | Returned to Australia 23 December 1918 |
