| Regimental number | 3176 |
| Place of birth | Sharon Queensland |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Bundaberg, Queensland |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs. Mary Elizabeth Fagg, Rockville Farm, Kolan river, South Queensland |
| Enlistment date | 4 December 1916 |
| Rank on enlistment | Private |
| Unit name | 2nd Light Horse Regiment, 25th Reinforcement |
| AWM Embarkation Roll number | 10/7/5 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Karmala on 3 February 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Light Horse Regiment |
| Fate | Returned to Australia 23 December 1918 |
