| Regimental number | 5977 |
| Place of birth | Heidelberg, Victoria |
| Religion | Church of England |
| Occupation | Student |
| Address | Bank Street, Alphington, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, Mr C Blackbourn, Bank Street, Alphington, Victoria |
| Enlistment date | 27 March 1916 |
| Rank on enlistment | Private |
| Unit name | 7th Battalion, 19th Reinforcement |
| AWM Embarkation Roll number | 23/24/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A32 Themistocles on 28 July 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Australian General Hospital |
| Fate | Returned to Australia 15 January 1919 |
