| Regimental number | 804 |
| Place of birth | Middlesex England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Eaton Street, Nundah, Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs N Pankhurst, 61 Crewys Road, Childs Hill, London, NW, England |
| Enlistment date | 31 March 1917 |
| Rank on enlistment | Private |
| Unit name | Machine Gun Company 12, Reinforcement 15 |
| AWM Embarkation Roll number | 24/17/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board SS Indarra on 26 November 1917 |
| Regimental number from Nominal Roll | 804a |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Machine Gun Battalion |
| Fate | Effective abroad (still overseas) |
