| Regimental number | 5123 |
| Place of birth | Maryborough Victoria |
| Religion | Church of England |
| Occupation | Nurseryman |
| Address | Boussole Road, Daceyville, New South Wales |
| Marital status | Single |
| Age at embarkation | 29 |
| Next of kin | Mother, Mrs R Jeremy, Boussole Road, Daceyville, New South Wales |
| Enlistment date | 14 March 1916 |
| Date of enlistment from Nominal Roll | 13 March 1916 |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/34/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A55 Kyarra on 5 June 1916 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 17th Battalion |
| Fate | Returned to Australia 24 January 1919 |
