| Regimental number | 4996 |
| Place of birth | Hawker, South Australia |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Wagga Wagga, New South Wales |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Mother, Mrs Annie Chamberlain, Wirrabara, South Australia |
| Previous military service | 34 |
| Enlistment date | 1 March 1917 |
| Rank on enlistment | Private |
| Unit name | 30th Battalion, 14th Reinforcement |
| AWM Embarkation Roll number | 23/47/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A74 Marathon on 10 May 1917 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 30th Battalion |
| Fate | Returned to Australia 5 July 1919 |
