| Regimental number | 66537 |
| Place of birth | Tarago New South Wales |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Moss Vale, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs H Tickner, 'Glenwood', Robertson Road, Moss Vale, New South Wales |
| Enlistment date | 9 March 1918 |
| Rank on enlistment | Private |
| Unit name | New South Wales Reinforcement 21 |
| AWM Embarkation Roll number | 23/111/6 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A36 Boonah on 22 October 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
