| Regimental number | 255 |
| Place of birth | Melbourne Victoria |
| Religion | Methodist |
| Occupation | Butcher |
| Address | 29 Argent Street, Broken Hill, New South Wales |
| Marital status | Married |
| Age at embarkation | 31 |
| Next of kin | Wife, Mrs. Fanny Ethel Jane Surplice, Londen Street, Job's Gully, Bendigo, Victoria |
| Enlistment date | 24 August 1914 |
| Rank on enlistment | Private |
| Unit name | 3rd Light Horse Regiment, B Squadron |
| AWM Embarkation Roll number | 10/8/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A17 Port Lincoln on 22 October 1914 |
| Regimental number from Nominal Roll | Commissioned |
| Rank from Nominal Roll | Lieutenant |
| Unit from Nominal Roll | 3rd Light Horse Regiment |
| Fate | Returned to Australia 6 May 1919 |
