| Regimental number | 21709 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Tram conductor |
| Address | South Melbourne, Victoria |
| Marital status | Married |
| Age at embarkation | 31 |
| Next of kin | Wife, Mrs E M Park, 7 Queen Street, South Melbourne, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A36 Boonah on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
