| Regimental number | 17016 |
| Place of birth | Grafton New South Wales |
| Religion | Church of England |
| Occupation | Grocer's assistant |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs B Cooper, Oliver Street, Grafton, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps February 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 9th Field Ambulance |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
