| Regimental number | 5170 |
| Place of birth | Surrey England |
| Religion | Methodist |
| Occupation | Labourer |
| Address | c/o B G Green, Carew Street, Katanning, Western Australia |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Mother, Mrs A Pepall, Van Newton, Valance near Alton Hants, England |
| Enlistment date | 8 February 1916 |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/33/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A9 Shropshire on 31 March 1916 |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | 16th Battalion |
| Fate | Returned to Australia 12 March 1918 |
