| Regimental number | 14613 |
| Place of birth | Booleroo Centre South Australia |
| Religion | Church of England |
| Occupation | Student |
| Address | Croydon, South Australia |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs J Kollosche, school residence, Croydon, South Australia |
| Enlistment date | 3 February 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, August 1916 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A73 Commonwealth on 21 September 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3 Field Ambulance |
| Fate | Effective abroad (still overseas) |
