| Regimental number | 3690 |
| Next of kin | Mrs K Corney, Redfern Street off Ipswich Road, South Brisbane, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 9th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/26/3 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A50 Itonus on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
| Date of death | |
| Place of burial | Mt Thompson Crematorium |