| Regimental number | 1004 |
| Place of birth | Merloneth Wales |
| Religion | Methodist |
| Occupation | Fitter |
| Marital status | Single |
| Age at embarkation | 33 |
| Next of kin | Sister, Mrs Margarit Ann Parry, 'Trefru', Towyn, North Wales, England |
| Enlistment date | 6 November 1916 |
| Rank on enlistment | Private |
| Unit name | Australian Flying Corps, No 4 Squadron, A Flight |
| AWM Embarkation Roll number | 8/7/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Omrah on 17 January 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Flying Corps |
| Fate | Returned to Australia 6 May 1919 |
