| Regimental number | 4755 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Blacksmith |
| Address | 13 Federal Street, Footscray, Melbourne, Victoria |
| Marital status | Married |
| Age at embarkation | 22 |
| Next of kin | Wife, Mrs Zoe Moth, 13 Federal Street, Footscray, Melbourne, Victoria |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/39/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A14 Euripides on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 22nd Battalion |
| Recommendations (Medals and Awards) |
Military Medal Recommendation date: |
| Fate | Returned to Australia |