| Regimental number | 9863 |
| Place of birth | Parramatta New South Wales |
| Religion | Presbyterian |
| Occupation | Meter reader |
| Address | 128 Phillip Street, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs Fanny Smith, 128 Phillip Street, Sydney, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 1st Light Horse Field Ambulance, 16th Reinforcement |
| AWM Embarkation Roll number | 26/39/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A53 Itria on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 14th Australian General Hospital |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
