| Regimental number | 3927 |
| Place of birth | Melbourne Victoria |
| Religion | Church of England |
| Occupation | Traveller |
| Address | 16 Federation Street, Ascot Vale, Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs Rubina F Simmons, 16 Federation Street, Ascot Vale, Melbourne, Victoria |
| Enlistment date | 12 July 1915 |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/39/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A69 Warilda on 8 February 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 22nd Battalion |
| Fate | Returned to Australia 12 March 1918 |
