| Regimental number | 664 |
| Place of birth | Benalla, Victoria |
| Religion | Church of England |
| Occupation | Draper |
| Address | Colac, Victoria |
| Marital status | Married |
| Age at embarkation | 29 |
| Next of kin | Wife, Mrs Edith Lizzie Clark, c/o A J Bellis, Lavery Street, Benalla, Victoria |
| Enlistment date | 2 March 1917 |
| Rank on enlistment | Private |
| Unit name | Machine Gun Company 10, Reinforcement 11 |
| AWM Embarkation Roll number | 24/15/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A29 Suevic on 21 June 1917 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
