| Regimental number | 6564 |
| Place of birth | Leeds England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Torbay, Western Australia |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs Etta Clark c/o Mrs Richardson, Swan Street, North Fremantle, Western Australia |
| Enlistment date | 20 June 1916 |
| Date of enlistment from Nominal Roll | 19 June 1916 |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/33/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A23 Suffolk on 13 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Australian General Hospital |
| Fate | Returned to Australia 3 July 1919 |
