| Regimental number | 66504 |
| Place of birth | Inverell New South Wales |
| Religion | Roman Catholic |
| Occupation | Mine manager |
| Address | Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 37 |
| Next of kin | Wife, Mrs M M Nicholls, 11 Crystal Street, Rozelle, New South Wales |
| Enlistment date | 14 August 1918 |
| Rank on enlistment | Private |
| Unit name | New South Wales Reinforcement 21 |
| AWM Embarkation Roll number | 23/111/6 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A36 Boonah on 22 October 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
