| Regimental number | 1663 |
| Place of birth | Carlton, Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Carlton, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Louisa Blake, 96 Park Street, West Brunswick, Victoria |
| Enlistment date | 8 November 1915 |
| Rank on enlistment | Private |
| Unit name | 58th Battalion, 2nd Reinforcement |
| AWM Embarkation Roll number | 23/75/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A14 Euripides on 4 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 58th Battalion |
| Fate | Returned to Australia 12 May 1918 |
