| Regimental number | 3456 |
| Religion | Church of England |
| Occupation | Driver |
| Address | Ascot Vale, Victoria |
| Marital status | Married |
| Age at embarkation | 23 |
| Next of kin | Wife, Mrs Annie Simmonds, 1 Holdsworth Street, Ascot Vale, Victoria |
| Enlistment date | 20 April 1917 |
| Rank on enlistment | Private |
| Unit name | 58th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/75/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A16 Port Melbourne on 16 July 1917 |
| Miscellaneous details (Nominal Roll) | crossed out |
