| Regimental number | 5228 |
| Place of birth | Birmingham England |
| Religion | Church of England |
| Occupation | Cook |
| Address | ... |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Step-Mother, Mrs Ada Ford, 53 Lansdowne Crescent, Hobart, Tasmania |
| Enlistment date | 25 January 1916 |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/29/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Orontes on 29 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Returned to Australia 20 May 1919 |
