| Regimental number | 1021 |
| Place of birth | Midland Junction, Western Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, H Company |
| AWM Embarkation Roll number | 23/29/1 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board Transport A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Returned to Australia |