| Regimental number | 3761 |
| Religion | Roman Catholic |
| Occupation | Undertaker |
| Address | 1 off Burnell Place, East Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 32 |
| Next of kin | Wife, Mrs F Derrick, 1 off Burnell Place, East Sydney, New South Wales |
| Enlistment date | 13 June 1915 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/19/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 30 December 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Battalion |
| Fate | Returned to Australia 11 April 1916 |
