| Regimental number | 4997 |
| Place of birth | Port Melbourne Victoria |
| Religion | Church of England |
| Occupation | Barbed wire machinist |
| Address | 186 Clarke Street, Port Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Mother, Mrs M Stivey, 184 Gladstone Street, South Melbourne, Victoria |
| Enlistment date | 15 July 1915 |
| Rank on enlistment | Private |
| Unit name | 5th Battalion, 15th Reinforcement |
| AWM Embarkation Roll number | 23/22/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A18 Wiltshire on 7 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Battalion |
| Fate | Returned to Australia 12 December 1918 |
