| Regimental number | 15643 |
| Place of birth | Glenelg, South Australia |
| Religion | Church of England |
| Occupation | Wardsman |
| Address | Broken Hill, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs M Dally, Alison Street, St Leonards, Glenelg, South Australia |
| Enlistment date | 27 April 1916 |
| Rank on enlistment | Private |
| Unit name | September 1916 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A16 Port Melbourne on 23 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Field Ambulance |
| Fate | Returned to Australia 25 November 1917 |
