| Regimental number | 4007 |
| Place of birth | Brunswick Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 6 Victoria Street, Northcote, Victoria |
| Marital status | Married |
| Age at embarkation | 23 |
| Next of kin | Wife, Mrs I Shaw, 6 Vic Street, Northcoate, Victoria |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 5th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/22/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A40 Ceramic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
