| Regimental number | 174 |
| Religion | Church of England |
| Occupation | Sailor |
| Address | Bendigo, Victoria |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs A Hazledine, 76 Langston Street, Bendigo, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | No 1 Australian General Hospital |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board A62 Wandilla on |
| Fate | No details of fate entered on Nominal Roll |