| Regimental number | 4490 |
| Place of birth | Maida Vale London |
| Religion | Church of England |
| Occupation | Valet |
| Address | 6 Smith Street, Manly, Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 23 |
| Next of kin | Wife, Mrs Elsa De Lacy Evans, 52 Belgrave Street, Manly, Sydney, New South Wales |
| Enlistment date | 5 April 1915 |
| Date of enlistment from Nominal Roll | 31 March 1915 |
| Unit name | No 3 Australian General Hospital |
| AWM Embarkation Roll number | 26/67/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Mooltan on 15 May 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Australian General Hospital |
| Fate | Returned to Australia 19 March 1916 |
