| Regimental number | 12775 |
| Place of birth | Wallaroo South Australia |
| Religion | Church of England |
| Occupation | Postal assistant |
| Address | 47 Hampton Street, Goodwood, South Australia |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs M Walsh, Wallaroo, South Australia |
| Previous military service | 76th Infantry |
| Enlistment date | 8 January 1916 |
| Rank on enlistment | Private |
| Unit name | 11th Field Ambulance |
| AWM Embarkation Roll number | 26/54/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A29 Suevic on 31 May 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
