| Regimental number | 4500 |
| Place of birth | Brisbane Queensland |
| Address | Hotel Mosman, Mosman, New South Wales |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Father, J B Cook, Hotel Mosman, Mosman, New South Wales |
| Enlistment date | 15 March 1915 |
| Rank on enlistment | Private |
| Unit name | No 3 Australian General Hospital |
| AWM Embarkation Roll number | 26/67/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Mooltan on 15 May 1915 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
