| Regimental number | 4717 |
| Place of birth | Burra, South Australia |
| Religion | Church of England |
| Occupation | Stockman |
| Address | Charlotte Place, South Terrace, Adelaide, South Australia |
| Marital status | Single |
| Age at embarkation | 33 |
| Next of kin | Mother, Mrs Bessie Clarke, c/o Mr W Jordan, Charlotte Place, South Terrace, Adelaide, South Australia |
| Enlistment date | 21 April 1915 |
| Rank on enlistment | Private |
| Unit name | Australian General Hospital 3, Reinforcement 1 |
| AWM Embarkation Roll number | 26/67/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A62 Wandilla on 15 June 1915 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
