| Regimental number | 4910 |
| Place of birth | Temora New South Wales |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Burke Street, Cootamundra, New South Wales |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Step-Father, Jack William Roberts, Burke Street, Cootamundra, New South Wales |
| Enlistment date | 12 September 1917 |
| Rank on enlistment | Private |
| Unit name | 1st Pioneer Battalion, 14th Reinforcement |
| AWM Embarkation Roll number | 14/13/5 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A38 Ulysses on 19 December 1917 |
