| Regimental number | 5058 |
| Place of birth | Goulburn New South Wales |
| Religion | Church of England |
| Occupation | Coal miner |
| Address | Co Mrs R Smith, Scarborough, South Coast, New South Wales |
| Marital status | Married |
| Age at embarkation | 31 |
| Next of kin | Wife, Mrs 0 R Charlton, C/o 1 Pollock, Cross Street, Corrimal, South Coast, New South Wales |
| Enlistment date | 18 January 1916 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/19/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A71 Nestor on 9 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Battalion |
| Fate | Returned to Australia 20 April 1919 |
