| Regimental number | 3369 |
| Place of birth | Albany Western Australia |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Dowerin, Western Australia |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs Daisy Winifred Roberts, Dowerin, Western Australia |
| Enlistment date | 14 March 1917 |
| Date of enlistment from Nominal Roll | 29 October 1916 |
| Rank on enlistment | Private |
| Unit name | 10th Light Horse Regiment, 28th Reinforcement |
| AWM Embarkation Roll number | 10/15/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A15 Port Sydney on 22 May 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 10th Light Horse Regiment |
| Fate | Returned to Australia 12 November 1917 |
