| Regimental number | 3789 |
| Place of birth | Baddesley England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Mrs Eva Lane, 392 Bridge Road, Richmond, Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, J Capelhorn, North Baddesley near Romsey, England |
| Enlistment date | 7 October 1915 |
| Date of enlistment from Nominal Roll | 18 July 1915 |
| Rank on enlistment | Private |
| Unit name | 21st Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/38/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A69 Warilda on 8 February 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 67th Battalion |
| Fate | Returned to Australia 27 August 1917 |
