| Regimental number | 5041 |
| Place of birth | Grafton New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Carr's Creek, Grafton, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs. E. Bollard, Carr's Creek, Grafton, New South Wales |
| Enlistment date | 12 January 1916 |
| Rank on enlistment | Private |
| Unit name | 4th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/21/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Makarini on 1 April 1916 |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | 56th Battalion |
| Fate | Returned to Australia 2 June 1919 |
