| Regimental number | 1641 |
| Place of birth | Enoggera Queensland |
| Religion | Methodist |
| Occupation | Timber getter |
| Address | Stafford Store, Kedron, Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 32 |
| Next of kin | Father, Charles Poultney, Stafford Store, Kedron, Brisbane, Queensland |
| Enlistment date | 10 August 1915 |
| Rank on enlistment | Private |
| Unit name | 2nd Light Horse Regiment, 12th Reinforcement |
| AWM Embarkation Roll number | 10/7/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A23 Suffolk on 30 November 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Light Horse Regiment |
| Fate | Returned to Australia 21 May 1916 |
