| Regimental number | 3917 |
| Place of birth | North Sydney New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 98 St Jame's Road, Waverley, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 39 |
| Next of kin | Mother, Mrs E Elliott, 98 St James Road, Waverley, Sydney, New South Wales |
| Enlistment date | 15 August 1915 |
| Rank on enlistment | Private |
| Unit name | 1st Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/18/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT Mooltan on 11 December 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Battalion |
| Fate | Returned to Australia 12 April 1916 |
