| Regimental number | 19005 |
| Place of birth | Alphington England |
| Religion | Church of Christ |
| Occupation | Orchardist |
| Address | Stanthorpe, Queensland |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs M E Roberts, Liston, Amosfield, Stanthorpe, Queensland |
| Enlistment date | 16 August 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Light Horse Field Ambulance |
| Fate | Returned to Australia 15 May 1919 |
