| Regimental number | 4083 |
| Religion | Church of England |
| Occupation | Woolblender |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs Alice Cantillon, 15 Barkly Street, Ballarat East, Victoria |
| Enlistment date | 10 January 1916 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/38/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A18 Wiltshire on 7 March 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |