| Regimental number | 1643 |
| Religion | Church of England |
| Occupation | Labourer |
| Address | c/o George Butt, The Terrace, Ipswich, Queensland |
| Marital status | Single |
| Age at embarkation | 31 |
| Next of kin | Father, W Surnam, Cowley Road, Littlemore, England |
| Enlistment date | 17 May 1915 |
| Rank on enlistment | Private |
| Unit name | 25th Battalion, 1st Reinforcement |
| AWM Embarkation Roll number | 23/42/2 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A60 Aeneas on 29 June 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 25th Battalion |
| Fate | Returned to Australia 12 November 1916 |
