| Regimental number | 5001 |
| Religion | Church of England |
| Occupation | Painter |
| Address | Main Street Canbelego, New South Wales |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs Sarah Cooper, Canbelego, New South Wales |
| Enlistment date | 18 February 1916 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/38/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A33 Ayrshire on 3 July 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
