| Regimental number | 2621 |
| Place of birth | Boolaroo New South Wales |
| Religion | Church of England |
| Occupation | Wharf labourer |
| Address | Fifth Street, Boolaroo, New South Wales |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs Hethia Dormer, Isaac Street, Toowoomba, Queensland |
| Enlistment date | 11 February 1916 |
| Rank on enlistment | Private |
| Unit name | 30th Battalion, 5th Reinforcement |
| AWM Embarkation Roll number | 23/47/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A71 Nestor on 9 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Machine Gun Battalion |
| Fate | Returned to Australia 11 December 1918 |
