| Regimental number | 6621 |
| Place of birth | Caulfield, Victoria |
| Religion | Church of England |
| Occupation | clerk |
| Address | 28 Tooronga Road, East Malvern, Victoria |
| Marital status | Single |
| Age at embarkation | 40 |
| Next of kin | Mother, Mrs M Broadbridge, Munga, Manning Road, East Malvern, Victoria |
| Enlistment date | 31 May 1916 |
| Rank on enlistment | Private |
| Unit name | 7th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/24/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 2 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 7th Battalion |
| Fate | Returned to Australia 4 May 1917 |
