| Regimental number | 4758 |
| Place of birth | Hindmarsh South Australia |
| Religion | Church of England |
| Occupation | Draper |
| Address | c/o P J Payne, Port Road, Hindmarsh, South Australia |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Father, Philip John Payne, Port Road, Hindmarsh, South Australia |
| Enlistment date | 5 May 1915 |
| Rank on enlistment | Private |
| Unit name | Australian General Hospital 3, Reinforcement 1 |
| AWM Embarkation Roll number | 26/67/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A62 Wandilla on 15 June 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Field Ambulance |
| Fate | Returned to Australia 6 May 1918 |
