| Regimental number | 1104 |
| Religion | Church of England |
| Occupation | Shop assistant |
| Address | c/o Mrs Emily Roberts, 104 Botany Road, Alexandria, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Emily Roberts, 104 Botany Road, Alexandria, New South Wales |
| Enlistment date | |
| Rank on enlistment | SIG |
| Unit name | 12th Light Horse Regiment, 5th Reinforcement |
| AWM Embarkation Roll number | 10/17/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A32 Themistocles on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
| Medals |
Military Medal Source: 'Commonwealth Gazette' No. 119 Date: |