| Regimental number | 6563 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 186 Liverpool Street, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Mother, Mrs C. Simmons, 11 Windmill Grove, Surrey, England |
| Enlistment date | 15 May 1916 |
| Rank on enlistment | Private |
| Unit name | 1st Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/18/4 |
| 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 | 1st Battalion |
| Fate | Effective abroad (still overseas) |
