| Regimental number | 21778 |
| Place of birth | West Hartlepool England |
| Religion | Church of England |
| Occupation | Hospital attendant |
| Address | Prahran, Victoria |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Mother, Mrs M A Challoner, 16 Ward Street, West Hartlepool, Durham, England |
| Enlistment date | 12 December 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Australian General Hospital |
| Fate | Returned to Australia 28 August 1919 |
