| Regimental number | 4721 |
| Place of birth | Thebarton, South Australia |
| Religion | Church of Christ |
| Occupation | Wardsman |
| Address | c/o Mrs E Douglas, Shipsters Road, Kensington, South Australia |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs Eliza Douglas, Shipsters Road, Kensington, South Australia |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | Australian General Hospital 3, Reinforcement 1 |
| AWM Embarkation Roll number | 26/67/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A62 Wandilla on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Field Ambulance |
| Fate | Returned to Australia |
| Date of death | |
| Age at death | 61 |
| Place of burial | AIF Cemetery (Row 5, Grave 38), West Terrace, Adelaide, South Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
