| Regimental number | 122 |
| Place of birth | Footscray, Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 26 Whitehall Street, Footscray, Victoria |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Marina Clack, 26 Whitehall Street, Footscray, Victoria |
| Enlistment date | 21 January 1915 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, A Company |
| AWM Embarkation Roll number | 23/38/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on 10 May 1915 |
| Regimental number from Nominal Roll | 6192 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Pioneer Battalion |
| Fate | Returned to Australia 19 June 1919 |
