| Regimental number | 22 |
| Place of birth | Melbourne, Victoria |
| Religion | Church of England |
| Occupation | Fireman |
| Address | 25 Frederick Street, Brunswick, Victoria |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | B Jacobson, Newport Workshops, Williamstown, Victoria |
| Previous military service | 63rd Infantry |
| Enlistment date | |
| Place of enlistment | Melbourne, Victoria |
| Rank on enlistment | Private |
| Unit name | Brigade 2 Headquarters |
| AWM Embarkation Roll number | 23/2/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board Transport A3 Orvieto on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Division Headquarters |
| Fate | Returned to Australia |
| Medals |
Meritorious Service Medal Source: 'Commonwealth Gazette' No. 173 Date: |