| Regimental number | 6569 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Pennant Hills West, New South Wales |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs R Shields, Pennant Hills West, New South Wales |
| Enlistment date | 15 March 1916 |
| Date of enlistment from Nominal Roll | 13 March 1916 |
| Rank on enlistment | Private |
| Unit name | 3rd Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/20/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 7 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Machine Gun Details |
| Fate | Returned to Australia 19 February 1919 |
