| Regimental number | 6489 |
| Place of birth | Drouin, Victoria |
| Religion | Church of England |
| Occupation | Rubber worker |
| Address | 75 Wilson Street, South Yarra, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, T B Clark, 75 Wilson Street, South Yarra, Victoria |
| Enlistment date | 15 June 1915 |
| Rank on enlistment | Private |
| Unit name | 14th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/31/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 2 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Australian General Hospital |
| Fate | Returned to Australia 16 March 1918 |
