| Regimental number | 4011 |
| Place of birth | Ballarat Victoria |
| Religion | Methodist |
| Occupation | Miner |
| Address | Kalgoorlie, Western Australia |
| Marital status | Single |
| Age at embarkation | 44 |
| Next of kin | Mother, Mrs M J Roberts, Hertsford Street, Sebastopol Ballarat, Victoria |
| Enlistment date | 25 August 1915 |
| Date of enlistment from Nominal Roll | 22 August 1915 |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/33/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A31 Ajana on 22 December 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 48th Battalion |
| Fate | Returned to Australia 22 July 1917 |
