| Regimental number | 419 |
| Date of birth | |
| Place of birth | Ballarat Vic |
| Religion | Roman Catholic |
| Occupation | Bookkeeper |
| Address | c/o Miss S Hickey, Wendouree Asylum, Ballarat, Victoria |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Sister, Miss Hickey, Wendouree Asylum, Ballarat, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Light Horse Regiment, C Squadron |
| AWM Embarkation Roll number | 10/9/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board Transport A18 Wiltshire on |
| Regimental number from Nominal Roll | Commissioned |
| Rank from Nominal Roll | Lieutenant |
| Unit from Nominal Roll | 4th Light Horse Regiment |
| Promotions |
2nd Lieutenant Unit: LH4 Promotion date: Lieutenant Unit: LH4 Promotion date: |
| Fate | Returned to Australia |