| Regimental number | 4091 |
| Place of birth | London, England |
| Religion | Church of England |
| Occupation | Miner |
| Address | Townsville, Queensland |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Mother, Mrs Harriett Adams, c/o Mrs E Raggett, 15 Southchurch Road, Southend-on-Sea, England |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Place of enlistment | Townsville, Queensland |
| Rank on enlistment | Private |
| Unit name | 25th Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/42/3 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT Commonwealth on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 25th Battalion |
| Fate | Returned to Australia |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |