| Regimental number | 382 |
| Place of birth | Plymouth England |
| Occupation | ... |
| Address | ... |
| Marital status | Single |
| Age at embarkation | ... |
| Next of kin | ..., ... |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 13th Battalion, D Company |
| AWM Embarkation Roll number | 23/30/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board Transport A38 Ulysses on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 45th Battalion |
| Fate | Discharged |