| Regimental number | 1134 |
| Place of birth | Bristol, England |
| Religion | Church of England |
| Occupation | Fireman |
| Address | Cannon Street, Port Adelaide, South Australia |
| Marital status | Married |
| Age at embarkation | 32 |
| Next of kin | Wife, Mrs Grace Lily Derrick, Cannon Street, Port Adelaide, South Australia |
| Enlistment date | |
| Place of enlistment | Blackboy Hill, Western Australia |
| Rank on enlistment | Private |
| Unit name | 3rd Pioneer Battalion, D Company |
| AWM Embarkation Roll number | 14/15/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A62 Wandilla on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Pioneer Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
