| Regimental number | 12636 |
| Place of birth | Gowler South Australia |
| Religion | Baptist |
| Occupation | Furniture warehouseman |
| Address | Kensington Road, Norwood, South Australia |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Lucy Ellen Lavis, Kensington Road, Norwood, South Australia |
| Enlistment date | 2 February 1916 |
| Rank on enlistment | Private |
| Unit name | 11th Field Ambulance |
| AWM Embarkation Roll number | 26/54/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A29 Suevic on 31 May 1916 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 3rd Motor Transport Company |
| Fate | Returned to Australia 23 March 1919 |
