| Regimental number | 4490 |
| Religion | Church of England |
| Occupation | Valet |
| Address | Manly, New South Wales |
| Marital status | Married |
| Age at embarkation | 24 |
| Next of kin | Wife, Mrs E De Lacy Evans, 13 Arthur Street, Manly, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 3rd Australian General Hospital |
| AWM Embarkation Roll number | 26/67/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Mooltan on |
| Miscellaneous details (Nominal Roll) | see other |