| Regimental number | 4767 |
| Place of birth | Bellerive Tasmania |
| Religion | Church of England |
| Occupation | Horse driver |
| Address | 7 Milton Street, Leichhardt, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, H Surman, 7 Milton Street, Leichhardt, New South Wales |
| Enlistment date | 21 January 1916 |
| Date of enlistment from Nominal Roll | 31 January 1916 |
| Rank on enlistment | Private |
| Unit name | 19th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/36/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 13 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Machine Gun Battalion |
| Fate | Returned to Australia 23 July 1919 |
