| Regimental number | 17647 |
| Place of birth | Bacchus Marsh Victoria |
| Religion | Church of England |
| Occupation | Manager |
| Address | Ballan, Victoria |
| Marital status | Married |
| Age at embarkation | 27 |
| Next of kin | Wife, Mrs F M Fagg, c/o Mrs G Flack, 'Bellevue', Ballan, Victoria |
| Enlistment date | 31 March 1916 |
| Date of enlistment from Nominal Roll | 29 January 1916 |
| Rank on enlistment | Private |
| Unit name | April 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A17 Port Lincoln on 22 June 1917 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 4th Light Horse Field Ambulance |
| Fate | Returned to Australia 16 March 1919 |
