| Regimental number | 4363 |
| Place of birth | Parramatta New South Wales |
| Religion | Baptist |
| Occupation | Machinist |
| Address | 91 Northumberland Road, Auburn, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs S J Crouch, 91 Northumberland Road, Auburn, New South Wales |
| Enlistment date | 25 October 1915 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/19/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A6 Aeneas on 20 December 1915 |
| Miscellaneous details (Nominal Roll) | missing page |
