| Regimental number | 5781 |
| Place of birth | Merimbula New South Wales |
| Religion | Church of England |
| Occupation | Carriage painter |
| Address | Washington Street, Rockdale, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Charlotte Amy, Washington Street, Rockdale, New South Wales |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/34/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Employment Company |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
