| Regimental number | 5057 |
| Place of birth | Pyrmont New South Wales |
| Religion | Church of England |
| Occupation | Marine fireman |
| Address | 155 Chandos Street, North Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs E Keizer, 2 Jenkins Street, Millers Point, Sydney, New South Wales |
| Enlistment date | 25 October 1915 |
| Date of enlistment from Nominal Roll | 4 November 1915 |
| Rank on enlistment | Private |
| Unit name | 18th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/35/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A55 Kyarra on 5 June 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 18th Battalion |
| Fate | Returned to Australia 19 June 1919 |
