| Place of birth | Sandhurst, Victoria |
| Religion | Presbyterian |
| Occupation | Dentist Lds Bds |
| Address | Bendigo, Victoria |
| Marital status | Married |
| Age at embarkation | 35 |
| Next of kin | Wife, Mrs I T Deravin, Forest Street, Bendigo, Victoria |
| Previous military service | Australian Army Medical Corps Res |
| Enlistment date | |
| Rank on enlistment | HON LT |
| Unit name | Dental Details |
| AWM Embarkation Roll number | 26/105/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on |
| Rank from Nominal Roll | Captain |
| Unit from Nominal Roll | Dental Corps |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
