| Regimental number | 21404 |
| Place of birth | East Cowes England |
| Religion | Church of England |
| Occupation | Soldier |
| Address | Fort Forrest, Western Australia |
| Marital status | Married |
| Age at embarkation | 27 |
| Next of kin | Wife, Mrs Enid Francesco Derham, c/o R.J. Gilman, Magic Street, Mosman, New South Wales |
| Previous military service | Royal Australian Engineers |
| Enlistment date | 1 December 1917 |
| Rank on enlistment | 2nd Corporal |
| Unit name | Special Draft |
| AWM Embarkation Roll number | 14/42/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A18 Wiltshire on 2 February 1918 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 15th Field Company Engineers |
| Fate | Returned to Australia 1 June 1919 |
