| Regimental number | 11212 |
| Place of birth | Kensington England |
| Religion | Church of England |
| Occupation | Motor builder |
| Address | Richmond, Victoria |
| Marital status | Married |
| Age at embarkation | 33 |
| Next of kin | Wife, Mrs E J Potter, 91 Buckingham Street, Richmond, Victoria |
| Enlistment date | 27 March 1916 |
| Rank on enlistment | Mechanic |
| Unit name | 3rd Division Ambulance Workshop |
| AWM Embarkation Roll number | 26/107/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A34 Persic on 3 June 1916 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 3rd Motor Transport Company |
| Fate | Returned to Australia 9 July 1919 |
