| Regimental number | 2016 |
| Place of birth | Waterloo Victoria |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Snake Valley via Ballarat, Victoria |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Annie Stevens, Snake Valley via Ballarat, Victoria |
| Enlistment date | 2 July 1915 |
| Rank on enlistment | Private |
| Unit name | 8th Light Horse Regiment, 9th Reinforcement |
| AWM Embarkation Roll number | 10/13/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A20 Hororata on 27 September 1915 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |