| Regimental number | 6103 |
| Place of birth | Orange New South Wales |
| Religion | Church of England |
| Occupation | Station hand |
| Address | c/o Mrs A M Cousins, Royston, Stuartown, New South Wales |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs A M Cousins, Royston, Stuartown, New South Wales |
| Enlistment date | 18 February 1915 |
| Rank on enlistment | Driver |
| Unit name | Infantry Brigade 5, 15th Company, Army Service Corps |
| AWM Embarkation Roll number | 25/103/1 |
| Embarkation details | Unit embarked from |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 15th Company, Australian Army Service Corps |
| Fate | Returned to Australia 8 April 1919 |
