| Regimental number | 19457 |
| Place of birth | Falmouth England |
| Religion | Church of England |
| Occupation | Printer |
| Address | South Coast, New South Wales |
| Marital status | Married |
| Age at embarkation | 26 |
| Next of kin | Wife, Mrs E E Champion, Wolseley, St Milton, South Coast, New South Wales |
| Enlistment date | 16 August 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, October 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Ormonde on 2 March 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia 22 June 1919 |
