| Regimental number | 12413 |
| Place of birth | Sussex England |
| Religion | Church of England |
| Occupation | Butcher |
| Address | Ultima, Victoria |
| Marital status | Married |
| Age at embarkation | 29 |
| Next of kin | W (not recognised), Mrs Beatrice Ticehurst, 18 Hardwick Road, Halton, Hastings, Sussex, England |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Field Ambulance 10 |
| AWM Embarkation Roll number | 26/53/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A54 Runic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 10th Field Ambulance |
| Fate | Returned to Australia |
| Date of death | |
| Place of burial | Ultima Cemetery |