| Regimental number | 6500 |
| Place of birth | Tarana New South Wales |
| Religion | Church of England |
| Occupation | Lorry driver |
| Address | McLaughlin Street, East Orange, New South Wales |
| Marital status | Single |
| Age at embarkation | 40 |
| Next of kin | Mother, Mrs. M. Jaques, Tarana, New South Wales |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 4th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/21/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A60 Aeneas on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
