| Regimental number | 21854 |
| Place of birth | Cumberland New South Wales |
| Religion | Church of England |
| Occupation | Dental mechanic |
| Address | Annandale, New South Wales |
| Marital status | Married |
| Age at embarkation | 24 |
| Next of kin | Wife, Mrs M V Jerrom, 29 Johnstone Street, Annandale, New South Wales |
| Enlistment date | 30 April 1917 |
| Rank on enlistment | Staff Sergeant |
| Unit name | Dental Details |
| AWM Embarkation Roll number | 26/105/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic Recalled on 2 November 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
