| Regimental number | 11269 |
| Place of birth | Clifton N/A |
| Religion | Church of England |
| Occupation | Storekeeper |
| Address | Lane Cove Road, Pymble, New South Wales |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Father, C Peterson, Lane Cove Road, Pymble, New South Wales |
| Enlistment date | 7 February 1916 |
| Rank on enlistment | Driver |
| Unit name | 3rd Divisional Train, 22nd-25th Companies Army Service Corps, 1st Reinforcement |
| AWM Embarkation Roll number | 25/16/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A34 Persic on 30 May 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Division Train |
| Fate | Returned to Australia 13 July 1919 |
