| Regimental number | 6458 |
| Place of birth | Shepparton, Victoria |
| Religion | Church of England |
| Occupation | Butcher |
| Address | Pine Lodge South, Shepparton, Victoria |
| Marital status | Single |
| Age at embarkation | 32 |
| Next of kin | Father, Mr C Adams, Pine Lodge South, Shepparton, Victoria |
| Enlistment date | 20 September 1915 |
| Date of enlistment from Nominal Roll | 20 September 1915 |
| Rank on enlistment | Private |
| Unit name | 5th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/22/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on 2 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Battalion |
| Fate | Returned to Australia 22 February 1917 |
