| Regimental number | 21097 |
| Place of birth | Tarnabulla Victoria |
| Religion | Presbyterian |
| Occupation | Telephone mechanic |
| Address | Elsternwick, Victoria |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs Mary Cousins, 12 Prentice Street, Elsternwick, Victoria |
| Enlistment date | 2 July 1917 |
| Date of enlistment from Nominal Roll | 30 June 1917 |
| Rank on enlistment | Sapper |
| Unit name | 1st to 5th Divisional Signal Companies and Signallers November 1917 Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 28 February 1918 |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | 6th Field Artillery Brigade |
| Fate | Returned to Australia 18 July 1919 |
