| Regimental number | 5864 |
| Place of birth | Staffordshire England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 97 Xmas Street, Northcote, Victoria |
| Marital status | Married |
| Age at embarkation | 44 |
| Next of kin | Wife, Mrs Ann Lavender 70 McCracken Street, Kensington, Victoria |
| Enlistment date | 8 June 1916 |
| Date of enlistment from Nominal Roll | 12 June 1916 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/38/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 2 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 21st Battalion |
| Fate | Returned to Australia 27 August 1917 |
