| Regimental number | 21777 |
| Place of birth | Galt Canada |
| Religion | Church of England |
| Occupation | Manager |
| Address | Caulfield, Victoria |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs A V Ward, 'Annray', Redan Road, Caulfield, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 13th Field Ambulance |
| Fate | Discharged |