| Regimental number | 3696 |
| Place of birth | Glossop England |
| Religion | Church of England |
| Occupation | Insurance agent |
| Address | Grenaby, Margaret Street, North Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 34 |
| Next of kin | Mrs B Blackburn, Grenaby, Margaret Street, North Sydney, New South Wales |
| Enlistment date | 13 August 1915 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/19/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 30 December 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 45th Battalion |
| Fate | Returned to Australia 5 April 1918 |
