| Regimental number | 15258 |
| Place of birth | Forth Tasmania |
| Religion | Congregational |
| Occupation | Labourer |
| Address | King Island, Tasmania |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs E Jordan, Forth, Tasmania |
| Enlistment date | 25 August 1915 |
| Rank on enlistment | Gunner |
| Unit name | Field Artillery Brigade 13, Reinforcement 3 |
| AWM Embarkation Roll number | 13/40/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A35 Berrima on 4 July 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
