| Regimental number | 6619 |
| Place of birth | Melbourne, Victoria |
| Religion | Church of England |
| Occupation | Cook |
| Address | Pirie Street, Adelaide, South Australia |
| Marital status | Single |
| Age at embarkation | 38 |
| Next of kin | Brother, C Avery, Essendon, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 10th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/27/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A16 Port Melbourne on |