| Regimental number | 1734 |
| Religion | Protestant |
| Occupation | Warder |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs R Stormouth, Greenfield Place, Blaenaven, Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | No 1 Australian General Hospital |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board A62 Wandilla on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |