| Regimental number | 6967 |
| Place of birth | Kent England |
| Religion | Baptist |
| Occupation | Traveller |
| Address | 3 The Boltons, off Church Street, Newcastle, New South Wales |
| Marital status | Single |
| Age at embarkation | 40 |
| Next of kin | Sister, Miss E B Clark, Regent's Road, Gillingham, Kent, England |
| Enlistment date | 1 October 1916 |
| Rank on enlistment | Private |
| Unit name | 4th Battalion, 23rd Reinforcement |
| AWM Embarkation Roll number | 23/21/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A29 Suevic on 11 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Battalion |
| Fate | Returned to Australia 11 December 1918 |
