| Regimental number | 4565 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 86 Raglan Street, Redfern, New South Wales |
| Marital status | Single |
| Age at embarkation | 36 |
| Next of kin | Mother, Mrs C Burgess, 93 Wellington Street, Waterloo, New South Wales |
| Enlistment date | 6 December 1915 |
| Rank on enlistment | Private |
| Unit name | 19th Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 23/36/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A71 Nestor on 9 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 17th Battalion |
| Fate | Returned to Australia 1 July 1919 |
