| Regimental number | 2628 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Loco cleaner |
| Address | C/o Mrs R Cook, Turramurra Avenue, Turramurra, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Aunt, Mrs Frances Cook, Turramurra Avenue, Turramurra, New South Wales |
| Enlistment date | 10 April 1916 |
| Rank on enlistment | Private |
| Unit name | 33rd Battalion, 5th Reinforcement |
| AWM Embarkation Roll number | 23/50/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Port Napier on 17 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 33rd Battalion |
| Fate | Returned to Australia 12 June 1919 |
