| Regimental number | 16807 |
| Place of birth | Battersea England |
| Religion | Church of England |
| Occupation | Storeman |
| Address | Percy Street, Newmarket, Queensland |
| Marital status | Married |
| Age at embarkation | 39 |
| Next of kin | Wife, Mrs Alice Taverner, Percy Street, Newmarket, Queensland |
| Enlistment date | 17 July 1916 |
| Rank on enlistment | Driver |
| Unit name | January 1917 Reinforcements |
| AWM Embarkation Roll number | 14/42/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Osterley on 10 February 1917 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 12th Field Company Engineers |
| Fate | Returned to Australia 15 April 1918 |