| Regimental number | 4091 |
| Place of birth | Birmingham England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 12 Myrtle Street, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 38 |
| Next of kin | Mother, Mrs. E. Ford, New Street, Alrechurch Birmingham, England |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 3rd Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/20/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Pioneer Battalion |
| Fate | Effective abroad (still overseas) |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
