| Regimental number | 21765 |
| Place of birth | Castlemaine Victoria |
| Religion | Church of England |
| Occupation | Salesman |
| Address | Castlemain, Victoria |
| Marital status | Single |
| Age at embarkation | 33 |
| Next of kin | Father, A Roberts, 'Broadoak', Castlemaine, Victoria |
| Enlistment date | 30 October 1917 |
| Date of enlistment from Nominal Roll | 29 October 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Effective abroad (still overseas) |
