| Regimental number | 6075 |
| Place of birth | Wigham England |
| Religion | Church of England |
| Occupation | Ironmoulder |
| Address | Rockdale Cottage, Norman Street, Lidcombe, New South Wales |
| Marital status | Married |
| Age at embarkation | 35 |
| Next of kin | Wife, Mrs Esther Ann Derbyshire, Rockdale Cottage, Norman Street, Lidcombe, New South Wales |
| Enlistment date | 3 July 1916 |
| Rank on enlistment | Private |
| Unit name | 20th Battalion, 17th Reinforcement |
| AWM Embarkation Roll number | 23/37/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A11 Ascanius on 25 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Australian Auxiliary Hospital |
| Fate | Returned to Australia 4 January 1919 |
