| Regimental number | 90 |
| Place of birth | Melbourne, Victoria |
| Other Names | Henry |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Victoria Barracks, Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Sister, Miss J Black, Bank Street, South Melburne, Victoria |
| Previous military service | Royal Australian Garrison Artillery |
| Enlistment date | |
| Rank on enlistment | Gunner |
| Unit name | Siege Artillery Brigade |
| AWM Embarkation Roll number | 13/49/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A67 Orsova on |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 36th Heavy Artillery Brigade |
| Recommendations (Medals and Awards) |
Meritorious Service Medal Recommendation date: |
| Fate | Returned to Australia |