| Regimental number | 5004 |
| Place of birth | Bognak England |
| Religion | Church of England |
| Occupation | Carpenter |
| Address | Victoria Park, Western Australia |
| Marital status | Married |
| Age at embarkation | 40 |
| Next of kin | Annie Davis, Bourke Street, Victoria Park, Western Australia |
| Enlistment date | 7 March 1916 |
| Rank on enlistment | Sapper |
| Unit name | Tunnelling Company 6, Reinforcement 1 |
| AWM Embarkation Roll number | 16/12/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A69 Warilda on 1 June 1916 |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | Tunnelling Companies Details |
| Fate | Returned to Australia 4 May 1917 |
