| Regimental number | 12604 |
| Place of birth | Adelaide, South Australia |
| Religion | Church of England |
| Occupation | Traveller |
| Address | 76 Hill Street, North Adelaide, South Australia |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs A F Clark, 76 Hill Street, North Adelaide, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 11th Field Ambulance |
| AWM Embarkation Roll number | 26/54/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A29 Suevic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 11th Field Ambulance |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in South Australian Garden of Remembrance |
| Date of death |