| Regimental number | 17643 |
| Place of birth | Melbourne Victoria |
| Religion | Church of England |
| Occupation | Tobacco worker |
| Address | South Yarra, Victoria |
| Marital status | Married |
| Age at embarkation | 25 |
| Next of kin | Wife, Mrs M A Smith, 54 Fawkner Street, South Yarra, Victoria |
| Enlistment date | 15 March 1914 |
| Date of enlistment from Nominal Roll | 21 February 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, March 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A29 Suevic on 21 June 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 13th Field Ambulance |
| Fate | Returned to Australia 23 June 1919 |
