| Regimental number | 4839 |
| Religion | Methodist |
| Occupation | Packer |
| Address | North Perth, Western Australia |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Mother, Mrs M Brokensha, 20 Norfolk Street, North Perth, Western Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | No 1 Australian General Hospital |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board A62 Wandilla on |