| Regimental number | 6112 |
| Place of birth | Marrickville New South Wales |
| Religion | Congregational |
| Occupation | Clerk |
| Address | Riverview Road, Marrickville, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs M Cotterell, Riverview Road, Marrickville, New South Wales |
| Enlistment date | 22 May 1915 |
| Rank on enlistment | Private |
| Unit name | 1st Field Ambulance, Reinforcement 11 |
| AWM Embarkation Roll number | 26/44/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT RMS Moldavia on 2 October 1915 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
