| Regimental number | 5164 |
| Place of birth | Young Wallsend New South Wales |
| Religion | Church of England |
| Occupation | Wheeler |
| Address | Broken Street, Tarrawanna, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, G. Nicholls, Broken Street, Tarrawanna, New South Wales |
| Enlistment date | 15 January 1916 |
| Date of enlistment from Nominal Roll | 18 January 1916 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/19/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A71 Nestor on 9 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | a I F H Q |
| Fate | Returned to Australia 4 July 1919 |
