| Regimental number | 5124 |
| Place of birth | St Leonards Tasmania |
| Religion | Church of England |
| Occupation | Miner |
| Address | Ulverstone, Tasmania |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs J Jordan, Ulverstone, Tasmania |
| Enlistment date | 11 January 1916 |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/29/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Orontes on 29 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Machine Gun Battalion |
| Fate | Returned to Australia 12 May 1919 |
