| Regimental number | 8170 |
| Religion | Church of England |
| Occupation | Electrical motorman |
| Address | Malvern, Victoria |
| Marital status | Married |
| Age at embarkation | 41 |
| Next of kin | Wife, Mrs A Cockram, 21 Evandale Road, Malvern, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 1 Australian General Hospital 1-6 Special Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on |
| Miscellaneous details (Nominal Roll) | see other |