| Regimental number | 111 |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Woodlands, Ann Street, Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Father, A Roberts, Balingup, Western Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Australian Naval & Military Expeditionary Force (Queensland Reinforcement) |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |