| Regimental number | 2636 |
| Place of birth | Carlton, Victoria |
| Religion | Church of England |
| Occupation | Motor driver |
| Address | Stanmore, New South Wales |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs Minnie Head, c/o Krakowski and Co, Elizabeth Street, Melbourne, Victoria |
| Enlistment date | 22 May 1916 |
| Rank on enlistment | Private |
| Unit name | 56th Battalion, 6th Reinforcement |
| AWM Embarkation Roll number | 23/73/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 7 October 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
