| Regimental number | 4270 |
| Marital status | ] |
| Next of kin | ] |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/38/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A18 Wiltshire on |
| Fate | No details of fate entered on Nominal Roll |