| Regimental number | 4009 |
| Place of birth | London England |
| Religion | Roman Catholic |
| Occupation | Fireman |
| Address | 44 Edward Street, Pyrmont, New South Wales |
| Marital status | Married |
| Age at embarkation | 34 |
| Next of kin | Wife, Mrs Lilian May Champion, 7 Horner Street, East Sydney, New South Wales |
| Enlistment date | 3 May 1916 |
| Rank on enlistment | Private |
| Unit name | 30th Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/47/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 7 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 30th Battalion |
| Fate | Effective abroad (still overseas) |
