| Regimental number | 5410 |
| Place of birth | Geelong, Victoria |
| Religion | Church of England |
| Occupation | Dairy farmer |
| Address | Jack River Post Office, Jack River, Victoria |
| Marital status | Married |
| Age at embarkation | 43 |
| Next of kin | Wife, Mrs Amy Emil Rose Shields,Jack River Post Office, Jack River, Victoria |
| Enlistment date | 2 March 1916 |
| Place of enlistment | Melbourne, Victoria |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 14th Reinforcement |
| AWM Embarkation Roll number | 23/38/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A32 Themistocles on 28 July 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
