| Regimental number | 5034 |
| Place of birth | Hempall England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | ... |
| Marital status | Single |
| Age at embarkation | 41 |
| Next of kin | Step-Brother, Mr A Nash, AIF, Blackboy Hill, Western Australia |
| Enlistment date | 11 November 1916 |
| Date of enlistment from Nominal Roll | 11 November 1915 |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/28/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A9 Shropshire on 31 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 11th Battalion |
| Fate | Returned to Australia 4 May 1917 |
