| Regimental number | 14922 |
| Place of birth | Ultimo New South Wales |
| Religion | Church of England |
| Occupation | Dental surgeon |
| Address | Warialda, New South Wales |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Mother, Mrs Nellie Everett, Veneta, View Street, Woolwich, Sydney, New South Wales |
| Enlistment date | 22 May 1916 |
| Rank on enlistment | Sapper |
| Unit name | |
| AWM Embarkation Roll number | 22/17/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Malwa on 22 July 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
