| Regimental number | 1117 |
| Place of birth | Port Wakefield, South Australia |
| Religion | Baptist |
| Occupation | Clerk |
| Address | Cavendish Street, Semaphore, South Australia |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs Ada Blackham, Cavendish Street, Semaphore, South Australia |
| Enlistment date | 25 September 1914 |
| Rank on enlistment | Private |
| Unit name | Stationary Hospital 1 |
| AWM Embarkation Roll number | 26/70/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A55 Kyarra on 5 December 1914 |
| Rank from Nominal Roll | Quartermaster and Honorary Lieutenant |
| Unit from Nominal Roll | 1st Stationary Hospital |
| Fate | Effective abroad (still overseas) |
