| Regimental number | 20054 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Engineer's apprentice |
| Address | Redfern, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs I Potter, 362 Cleveland Street, Redfern, New South Wales |
| Previous military service | 28th Infantry |
| Enlistment date | 10 September 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board SS Gaika on 6 August 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Light Horse Regiment |
| Fate | Returned to Australia 20 July 1919 |
