| Regimental number | 5249 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Polo pony trainer |
| Address | Victoria Avenue, Concord West, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Rose Annie Clark, Victoria Avenue, Concord West, New South Wales |
| Enlistment date | |
| Rank on enlistment | Driver |
| Unit name | Field Artillery Brigade 1, Reinforcement 10 |
| AWM Embarkation Roll number | 13/29/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A20 Hororata on |
| Rank from Nominal Roll | Bombardier |
| Unit from Nominal Roll | 1st Divisional Ammunition Column |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
