| Regimental number | 1123 |
| Place of birth | White Cliffs New South Wales |
| Religion | Church of England |
| Occupation | Plumber |
| Address | 90 Margaret Street, North Adelaide, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs. Jane Smith, 90 Margaret Street, North Adelaide, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 9th Light Horse Regiment, 8th Reinforcement |
| AWM Embarkation Roll number | 10/14/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT Morea on |
| Miscellaneous details (Nominal Roll) | page missing |
| Medals |
Military Medal 'For bravery in the field.'
Source: 'Commonwealth Gazette' No. 219 Date: |