| Regimental number | 6367 |
| Place of birth | Uralla New South Wales |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Darwin, Northern Territory |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs J Madsen, Port Darwin, Northern Territory |
| Enlistment date | 8 May 1916 |
| Rank on enlistment | Private |
| Unit name | 9th Battalion, 20th Reinforcement |
| AWM Embarkation Roll number | 23/26/4 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A46 Clan Mcgillivray on 7 September 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 9th Battalion |
| Fate | Returned to Australia 5 September 1919 |
