| Regimental number | 6004 |
| Religion | Church of England |
| Occupation | Draper |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Father, T H Fallows, Lindum, Wynnum, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 1 Australian General Hospital 1-6 Special Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A71 Nestor on |
| Miscellaneous details (Nominal Roll) | see other |