| Regimental number | 1522 |
| Religion | Church of England |
| Occupation | Stockman |
| Address | Station Street, Berwick, Victoria |
| Marital status | Single |
| Age at embarkation | 42 |
| Next of kin | Mother, Mrs E Wallace, Station Street, Berwick, Victoria |
| Enlistment date | 6 September 1918 |
| Rank on enlistment | Private |
| Unit name | Australian Naval and Military Expeditionary Force, Army Medical Corps |
| AWM Embarkation Roll number | 23/112/5 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Melusia on 2 October 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
