| Regimental number | 15120 |
| Place of birth | Andelst Holland |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Kukerim, Western Australia |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Sister, Miss L Penraat, Amdelst, Holland |
| Enlistment date | 16 November 1915 |
| Rank on enlistment | Gunner |
| Unit name | Field Artillery Brigade 10, Reinforcement 2 |
| AWM Embarkation Roll number | 13/37/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A17 Port Lincoln on 4 May 1916 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 12th Field Artillery Brigade |
| Fate | Returned to Australia 4 June 1919 |
