| Regimental number | 17577 |
| Religion | Church of England |
| Occupation | Shop assistant |
| Address | 'Daisy Bank', Whiting Street, Gore Hill, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Daisy Blaw, 'Daisy Bank', Whiting Stret, Gore Hill, Sydney, New South Wales |
| Previous military service | 7th A A MC |
| Enlistment date | 5 July 1916 |
| Rank on enlistment | Private |
| Unit name | 1st Light Horse Field Ambulance, 28th Reinforcement |
| AWM Embarkation Roll number | 26/39/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A17 Port Lincoln on 11 June 1917 |
| Miscellaneous details (Nominal Roll) | see other |
