| Regimental number | 3417 |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Rockhampton, Queensland |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs J Shillam, Norman Street, Rockhampton, Queensland |
| Enlistment date | 17 January 1916 |
| Rank on enlistment | Sapper |
| Unit name | |
| AWM Embarkation Roll number | 16/13/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A69 Warilda on 22 May 1916 |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | 1st Tunnelling Company |
| Fate | Returned to Australia 23 July 1919 |
| Miscellaneous details (Nominal Roll) | *Second entry both matched |
