| Regimental number | 5128 |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/34/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A55 Kyarra on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |