| Regimental number | 67495 |
| Place of birth | Rockley New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 102 Stewart Street, Bathurst, New South Wales |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs J Cotterill, 102 Stewart Street, Bathurst, New South Wales |
| Enlistment date | 14 August 1918 |
| Rank on enlistment | Private |
| Unit name | New South Wales Reinforcement 25 |
| AWM Embarkation Roll number | 23/111/6 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Carpentaria on 7 November 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
