| Regimental number | 1173 |
| Religion | Methodist |
| Occupation | Navvy |
| Address | Fryerstown, Victoria |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs S. potter, Fryerstown, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Light Horse Regiment, 8th Reinforcement |
| AWM Embarkation Roll number | 10/9/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A55 Kyarra on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |