| Regimental number | 4217 |
| Place of birth | Manchester England |
| Religion | Church of England |
| Occupation | Mill hand |
| Address | 133 Townsend Street, Subiaco, Western Australia |
| Marital status | Married |
| Age at embarkation | 43 |
| Next of kin | Wife, Mrs M A Haynes, 133 Townsend Street, Subiaco, Western Australia |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/28/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A30 Borda on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Pioneer Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
