| Regimental number | 69257 |
| Place of birth | Carlton, Victoria |
| Religion | Church of England |
| Occupation | Fitter |
| Address | 25 Merrie Street, Brunswick, Victoria |
| Marital status | Married |
| Age at embarkation | 38 |
| Next of kin | Wife, Mrs E A Ellis, 25 Merrie Street, Brunswick, Victoria |
| Enlistment date | 17 August 1918 |
| Rank on enlistment | Private |
| Unit name | 17th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 2 November 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
