| Regimental number | 3653 |
| Religion | Church of England |
| Occupation | Horse breaker |
| Address | North Carlton, Victoria |
| Marital status | Single |
| Age at embarkation | 32 |
| Next of kin | Father, C C Tisell, 307 Canning Street, North Carlton, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Light Horse Regiment, 28th Reinforcement |
| AWM Embarkation Roll number | 10/9/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A17 Port Lincoln on |
| Miscellaneous details (Nominal Roll) | missing page |
| Miscellaneous information from cemetery records | Plaque in Victorian Garden of Remembrance |
| Date of death |