| Regimental number | 61836 |
| Place of birth | Ballarat, Victoria |
| Religion | Methodist |
| Occupation | Butcher |
| Address | 108 Humffray Street, Ballarat East, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs M J Clark, 108 Humffray Street, Ballarat East, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 13th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board SS Zealandic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Effective abroad (still overseas) |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
