| Regimental number | 2630 |
| Place of birth | Seven Hills South Australia |
| Religion | Roman Catholic |
| Occupation | Bootmaker |
| Address | Keswick, South Australia |
| Marital status | Married |
| Age at embarkation | 40 |
| Next of kin | Wife, Mrs Agnes Jane Kozlowski, Hampton Road, Keswick, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 5th Pioneer Battalion, Reinforcement 5 |
| AWM Embarkation Roll number | 14/17/3 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A73 Commonwealth on |
| Regimental number from Nominal Roll | 2630a |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Pioneer Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
