| Regimental number | 1764 |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Ballina, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Father, W Shaw, 106 Boynton Street, Bradford, Yorks, England |
| Enlistment date | 22 July 1915 |
| Rank on enlistment | Private |
| Unit name | 1 Australian General Hospital 1-6 Special Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 11 October 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Australian General Hospital |
| Fate | Discharged 8 September 1919 |
| Miscellaneous details (Nominal Roll) | *Second entry both matched |
