| Regimental number | 2804 |
| Place of birth | Elsternwick Victoria |
| Religion | Church of England |
| Occupation | Dental mechanic |
| Address | 247 Park street South Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs M F Shellard, 150 Glass Street, Essendon, Victoria |
| Enlistment date | 19 July 1915 |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion, 6th Reinforcement |
| AWM Embarkation Roll number | 23/39/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on 27 October 1915 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | a PROV C |
| Fate | Effective abroad (still overseas) |
