| Regimental number | 4767 |
| Place of birth | Russia |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Marital status | Married |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs M Chepurnoff, Penza, Andreweeka, Russia |
| Enlistment date | 6 December 1915 |
| Rank on enlistment | Private |
| Unit name | 14th Battalion, 15th Reinforcement |
| AWM Embarkation Roll number | 23/31/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A68 Anchises on 14 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 46th Battalion |
| Fate | Returned to Australia 27 August 1917 |
