| Regimental number | 4910 |
| Religion | Church of England |
| Occupation | Last maker |
| Address | Collingwood, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs Emily Betts, 1 Otter Street, Collingwood, Victoria |
| Enlistment date | 8 March 1917 |
| Rank on enlistment | Private |
| Unit name | 29th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/46/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A29 Suevic on 21 June 1917 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
