| Regimental number | 19122 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Wire worker |
| Address | Burnley, Victoria |
| Marital status | Married |
| Age at embarkation | 44 |
| Next of kin | Wife, Mrs F Shields, 255 Stawell Street, Burnley, Victoria |
| Enlistment date | 19 June 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, September 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on 22 December 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia 22 August 1919 |
