| Regimental number | 4661 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Victoria Cafe, Russell Street, Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs Letitia Shepherd, 21 Petley Road, Fulham, England |
| Enlistment date | 5 July 1916 |
| Rank on enlistment | Private |
| Unit name | 29th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/46/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A7 Medic on 16 December 1916 |
