| Regimental number | 13191 |
| Place of birth | Bolton England |
| Religion | Church of England |
| Occupation | Attendant |
| Address | Claremont, Western Australia |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs E M Southworth, 17 Lime Street, Farnworth, Bolton, Lancaster, England |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A63 Karoola on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 15th Field Ambulance |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in Western Australia Garden of Remembrance |
| Date of death |