| Regimental number | 921 |
| Occupation | Sailor |
| Address | 7 Princes Street, Dawes Point, Sydney, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Australian Naval & Military Expeditionary Force, Tropical Unit, Headquarters |
| AWM Embarkation Roll number | 23/112/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A35 Berrima on |
| Fate | No details of fate entered on Nominal Roll |