| Regimental number | 4208 |
| Place of birth | Ivanhoe New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Cootamundra, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Father, Richard Clark, Moore Street, Wilcannia, New South Wales |
| Enlistment date | 5 December 1916 |
| Rank on enlistment | Private |
| Unit name | 1st Pioneer Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 14/13/5 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on 16 June 1917 |
