| Regimental number | 12811 |
| Place of birth | Saddleworth South Australia |
| Religion | Church of England |
| Occupation | Fitter Asst |
| Address | c/o Mrs J F Clisby, Duke Street, Alberton, South Australia |
| Marital status | Married |
| Next of kin | Wife, Mrs Coral Crystal Menz, c/o Mrs J F Clisby, Duke Street, Alberton, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | MED26.54.1SUPP |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 11th Field Ambulance |
| Fate | Returned to Australia |