| Regimental number | 17216 |
| Religion | Methodist |
| Occupation | Driver |
| Address | 18 Alberto Street, Leichhardt, Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 34 |
| Next of kin | Wife, Mrs R L Anderson, 18 Alberto Street, Leichhardt, Sydney, New South Wales |
| Enlistment date | 17 November 1915 |
| Rank on enlistment | Gunner |
| Unit name | Divisional Ammunition Column 5, Reinforcement 3 |
| AWM Embarkation Roll number | 25/93/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A69 Warilda on 22 May 1916 |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 5th Divisional Ammunition Column |
| Fate | Returned to Australia 13 February 1917 |
