| Regimental number | 5828 |
| Place of birth | SA |
| Religion | Church of England |
| Occupation | Slaughterman |
| Address | Leonora, Western Australia |
| Marital status | Married |
| Age at embarkation | 35 |
| Next of kin | Wife, Mrs Emily Davis, 60 Wilson Street, Kalgoorlie, Western Australia |
| Enlistment date | 29 May 1916 |
| Rank on enlistment | Private |
| Unit name | 27th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/44/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A16 Port Melbourne on 30 October 1916 |
| Regimental number from Nominal Roll | 5828A |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 28th Battalion |
| Fate | Returned to Australia 5 April 1918 |
