| Regimental number | 200 |
| Place of birth | Kelmscott, Western Australia |
| Religion | Church of England |
| Occupation | Carpenter |
| Address | c/o C Fancote, Kelmscott, Western Australia |
| Marital status | Single |
| Age at embarkation | 25 |
| Height | 5' 7.5" |
| Weight | 145 lbs |
| Next of kin | Mrs C Fancote, Kelmscott, Western Australia |
| Enlistment date | 17 August 1914 |
| Place of enlistment | Blackboy Hill, Western Australia |
| Rank on enlistment | Sapper |
| Unit name | 3rd Field Company Engineers, Section 3 |
| AWM Embarkation Roll number | 14/22/1 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board Transport A7 Medic on 2 November 1914 |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | 3rd Field Company Engineers |
| Fate | Returned to Australia 11 November 1918 |
| Miscellaneous details (Nominal Roll) | *Date of Fate could be 11/1/18 |
