| Regimental number | 3621 |
| Place of birth | Stawell, Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Callawadda, via Stawell, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, Robert Clark, Callawadda PO, via Stawell, Victoria |
| Enlistment date | 6 March 1917 |
| Rank on enlistment | Private |
| Unit name | 4th Light Horse Regiment, 28th Reinforcement |
| AWM Embarkation Roll number | 10/9/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A55 Kyarra on 7 September 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Light Horse Regiment |
| Fate | Returned to Australia 15 June 1919 |
