| Regimental number | 1907 |
| Religion | Church of England |
| Occupation | Farm labourer |
| Address | Narracan, Victoria |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, Mr Derham, 22 Prince Regent's Lane, Plaistow, England |
| Enlistment date | 22 February 1916 |
| Rank on enlistment | Private |
| Unit name | 57th Battalion, 3rd Reinforcement |
| AWM Embarkation Roll number | 23/74/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A31 Ajana on 8 July 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Motor Transport Company |
| Fate | Returned to Australia 6 September 1919 |
