| Regimental number | 12699 |
| Place of birth | Burnham England |
| Religion | Church of England |
| Occupation | Ambulance officer |
| Address | Wolfram Lane, off McCullock Street, North Broken Hill, New South Wales |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Father, Wm Blackman, 18 North End, Burnham, Bucks, England |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 11th Field Ambulance |
| AWM Embarkation Roll number | 26/54/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A29 Suevic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 11th Field Ambulance |
| Fate | Returned to Australia |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |