| Regimental number | 2820 |
| Religion | Church of England |
| Occupation | Motor-driver and mechanic |
| Address | 167 Wilson Street, Newtown, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Mother, Mrs Kathleen Vernon Botha, 167 Wilson Street, Newtown, Sydney, New South Wales |
| Enlistment date | 16 November 1916 |
| Rank on enlistment | Private |
| Unit name | 36th Battalion, 6th Reinforcement |
| AWM Embarkation Roll number | 23/53/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on 25 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 36th Battalion |
| Fate | Returned to Australia 12 May 1918 |
