| Regimental number | 13840 |
| Place of birth | Riverton South Australia |
| Religion | Methodist |
| Occupation | Bank clerk |
| Address | Trundle, New South Wales |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Father, E Southwell, Trundle, New South Wales |
| Enlistment date | 15 November 1915 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A61 Kanowna on 29 March 1916 |
| Rank from Nominal Roll | 2nd Corporal |
| Unit from Nominal Roll | AIF Headquarters |
| Fate | Returned to Australia 17 January 1919 |
