| Regimental number | 21684 |
| Place of birth | Hawthorn Victoria |
| Religion | Church of England |
| Occupation | Motor mechanic |
| Address | Hawthorn, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, R Cousins, 11 Marian Street, Hawthorn, Victoria |
| Enlistment date | 5 June 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A36 Boonah on 22 October 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Australian General Hospital |
| Fate | Returned to Australia 17 March 1919 |
