| Regimental number | 13639 |
| Place of birth | Somerset England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Bulimba, Queensland |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs C Perry, North Perratt, near Crewkerne, Somersetshire, England |
| Enlistment date | 16 August 1915 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A61 Kanowna on 29 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 14th Australian General Hospital |
| Fate | Returned to Australia 28 March 1919 |
