| Regimental number | N/E |
| Religion | Roman Catholic |
| Occupation | Fireman |
| Address | Middle Park, Victoria |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | mother, Mrs Mary Kelly, 84 Harold Street, Middle Park, Victoria |
| Enlistment date | |
| Rank on enlistment | Sapper |
| Unit name | Mining Corps 1, Company 1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A38 Ulysses on |
| Miscellaneous details (Nominal Roll) | see other |