| Regimental number | 3991 |
| Place of birth | Roma Queensland |
| Religion | Methodist |
| Occupation | Gunner |
| Address | Commercial Hotel, Main Street, Lithgow, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs M Roberts, Commercial Hotel, Main Street, Lithgow, New South Wales |
| Enlistment date | 31 October 1914 |
| Rank on enlistment | Private |
| Unit name | 5th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/22/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A40 Ceramic on 23 November 1915 |
| Regimental number from Nominal Roll | R1217 |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | 45th Battalion |
| Fate | Returned to Australia 5 April 1919 |
