| Regimental number | 5059 |
| Place of birth | London England |
| Religion | Church of England |
| Occupation | Seaman |
| Address | 14 Sutherland Street, Paddington, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs A Cook, Trelawn Road, Brixton, London, England |
| Enlistment date | 3 January 1916 |
| Rank on enlistment | Private |
| Unit name | 3rd Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/20/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT SS Makarini on 1 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Battalion |
| Fate | Returned to Australia 10 January 1918 |
