| Regimental number | 4830 |
| Place of birth | Sydney New South Wales |
| Religion | Roman Catholic |
| Occupation | Salesman |
| Address | Brisbane, Queensland |
| Marital status | Married |
| Age at embarkation | 26 |
| Next of kin | Wife, Mrs. Blanch Ada Lazarus, 3 Catherine Street, Forest Lodge, New South Wales |
| Enlistment date | 5 December 1916 |
| Rank on enlistment | Private |
| Unit name | 31st Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/48/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A18 Wiltshire on 7 February 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 31st Battalion |
| Fate | Returned to Australia 21 April 1918 |
