| Regimental number | 5122 |
| Place of birth | Quirind New South Wales |
| Religion | Roman Catholic |
| Occupation | Engine cleaner |
| Address | Venn Street, Collie, Western Australia |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs E Jack, Venn Street, Collie, Western Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/33/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A9 Shropshire on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 48th Battalion |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in Western Australia Garden of Remembrance |
| Date of death |