| Regimental number | 17614 |
| Place of birth | Launceston Tasmania |
| Religion | Church of England |
| Occupation | Driver |
| Address | Fitzroy, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs R Cousins, 220 Gertrude Street, Fitzroy, Victoria |
| Enlistment date | 31 March 1916 |
| Date of enlistment from Nominal Roll | 9 March 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, March 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A29 Suevic on 21 June 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Field Ambulance |
| Fate | Returned to Australia 4 July 1919 |
