| Regimental number | 4756 |
| Place of birth | Paskeville, South Australia |
| Religion | Church of England |
| Occupation | Farmer |
| Address | c/o Mrs G Palm, Edillilie, Eyre's Peninsula, West Coast, South Australia |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs Georgina Palm, Edillilie, Eyre's Peninsula, West Coast, South Australia |
| Enlistment date | 22 April 1915 |
| Place of enlistment | Adelaide, South Australia |
| Rank on enlistment | Private |
| Unit name | Australian General Hospital 3, Reinforcement 1 |
| AWM Embarkation Roll number | 26/67/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A62 Wandilla on 15 June 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia 4 July 1919 |
