| Regimental number | 4004 |
| Place of birth | Worcester England |
| Religion | Church of England |
| Occupation | Miner |
| Address | 23 Newington Road, Marrickville, New South Wales |
| Marital status | Married |
| Age at embarkation | 39 |
| Next of kin | Wife, Mrs E L Lane, 23 Newintgon Road, Marrickville, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/21/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
