| Regimental number | 1776 |
| Place of birth | Wargrave England |
| Religion | Church of England |
| Occupation | Gardener |
| Address | 56 Canterbury Road, Surrey Hills, Victoria |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Mother, Mrs Sarah Kasia Mary Surrey, 33 Nutford Place, Edgeware Road, London, W, England |
| Enlistment date | 22 February 1916 |
| Rank on enlistment | Private |
| Unit name | 57th Battalion, 2nd Reinforcement |
| AWM Embarkation Roll number | 23/74/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A14 Euripides on 4 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 58th Battalion |
| Fate | Effective abroad (still overseas) |
