| Regimental number | 4658 |
| Place of birth | Blayney New South Wales |
| Religion | Roman Catholic |
| Occupation | Miner |
| Address | Canbelego, New South Wales |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs Clara A Payne, 62 Sheppard Street, Sydney, New South Wales |
| Enlistment date | 28 September 1916 |
| Rank on enlistment | Private |
| Unit name | 30th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/47/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on 25 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | ADUS |
| Fate | Returned to Australia 7 February 1919 |
