| Regimental number | 6828 |
| Place of birth | Urana New South Wales |
| Religion | Church of England |
| Occupation | Cook |
| Address | Fairlie Grange, Jerilderie, New South Wales |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Mother, Mrs E. Simon, Corowa, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 7th Battalion, 22nd Reinforcement |
| AWM Embarkation Roll number | 23/24/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT SS Port Napier on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 7th Battalion |
| Fate | Returned to Australia |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |