| Regimental number | 13666 |
| Place of birth | Holbeach England |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Mons, Bunderim Line, via Palmwoods, Queensland |
| Marital status | Single |
| Age at embarkation | 38 |
| Next of kin | Mother, Mrs J Vise, Halbeach, Lincolnshire, England |
| Enlistment date | 29 October 1915 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A61 Kanowna on 29 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Australian Auxiliary Hospital |
| Fate | Returned to Australia 27 July 1917 |
