| Regimental number | 5004 |
| Place of birth | Bristol, England |
| Religion | Church of England |
| Occupation | Machinist |
| Address | 1 Henderson Road, Alexandria, Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 40 |
| Next of kin | Friend, G Hartley, 138 Redfern Street, Redfern, sydney, New South Wales |
| Enlistment date | 12 January 1916 |
| Date of enlistment from Nominal Roll | 19 January 1916 |
| Place of enlistment | Casula, New South Wales |
| Rank on enlistment | Private |
| Unit name | 18th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/35/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A55 Kyarra on 5 June 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 18th Battalion |
| Fate | Returned to Australia 13 February 1917 |
