| Regimental number | 6904 |
| Place of birth | South Yarra Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Prahran, Victoria |
| Marital status | Single |
| Age at embarkation | 29 |
| Next of kin | Sister, Mrs Janet Richardson, 14 Finlay Street, Albert Park, Victoria |
| Enlistment date | 6 February 1917 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 19th Reinforcement |
| AWM Embarkation Roll number | 23/38/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A11 Ascanius on 11 May 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 21st Battalion |
| Fate | Returned to Australia 26 September 1917 |
