| Regimental number | 17380 |
| Place of birth | Port Melbourne Victoria |
| Religion | Congregational |
| Occupation | Clerk |
| Address | North Fitzroy, Victoria |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Mother, Mrs E Shaw, 88 Newry Street, North Fitzroy, Victoria |
| Previous military service | 60th Infantry |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, March 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A15 Port Sydney on |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 3rd Light Horse Field Ambulance |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
