| Regimental number | 8121 |
| Religion | Church of England |
| Occupation | Storeman |
| Address | St Peters, New South Wales |
| Marital status | Married |
| Age at embarkation | 24 |
| Next of kin | Wife, Mrs E E Pascoe, 6 Park Road, St Peters, New South Wales |
| Enlistment date | 9 July 1915 |
| Rank on enlistment | Private |
| Unit name | 1 Australian General Hospital 1-6 Special Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 11 October 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps Details |
| Fate | Returned to Australia 21 July 1917 |
