| Regimental number | 3402 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Packer |
| Address | 22 Spring Street, North Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Father, S Potts, 22 Spring Street, North Sydney, New South Wales |
| Enlistment date | 7 September 1915 |
| Rank on enlistment | Private |
| Unit name | 3rd Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 23/20/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A14 Euripides on 2 November 1915 |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | army Employment Company |
| Fate | Returned to Australia 7 February 1919 |
