| Regimental number | 7775 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Carpenter |
| Address | Willoughby, New South Wales |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs E Petersen, Neville Street, Willoughby, New South Wales |
| Previous military service | 5th Australian Army Medical Corps |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | First Australian General Hospital, Special Reinforcements |
| AWM Embarkation Roll number | 26.65.3RSSPEC |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A67 Orsova on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
