| Regimental number | 4500 |
| Place of birth | Adelaide South Australia |
| Religion | Church of England |
| Occupation | Watchmaker |
| Address | Rosney Street, Hawthorn, Victoria |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Mother, Mrs Caroline Paqualin c/o Miss Selway, Frederick Street, Gilberton, South Australia |
| Enlistment date | 18 December 1915 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 23/38/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Orontes on 29 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 21st Battalion |
| Fate | Returned to Australia 19 October 1917 |
