| Regimental number | 4203 |
| Place of birth | Harden New South Wales |
| Religion | Church of England |
| Occupation | Harness worker |
| Address | 'Ashford', Park Road, Burwood, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Grandparent, A Peterson, 'Ashford', Park Road, Burwood, New South Wales |
| Previous military service | 39th Infantry |
| Enlistment date | 6 October 1915 |
| Rank on enlistment | Private |
| Unit name | 19th Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/36/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A67 Orsova on 11 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 19th Battalion |
| Fate | Returned to Australia 18 October 1917 |
