| Regimental number | 6120 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | School teacher |
| Address | 'Melenda', 6 Harbour Street, Mosman, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs M Jacob, 'Melenda', 6 Harbour Street, Mosman, Sydney, New South Wales |
| Enlistment date | 3 June 1915 |
| Rank on enlistment | Private |
| Unit name | 1st Field Ambulance, Reinforcement 11 |
| AWM Embarkation Roll number | 26/44/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT RMS Moldavia on 2 October 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia 23 September 1919 |
