| Regimental number | 4997 |
| Place of birth | Tuena New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | PO, Tuena, New South Wales |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs M E Cooper, PO, Tuena, New South Wales |
| Enlistment date | 7 January 1916 |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/34/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A55 Kyarra on 5 June 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 33rd Battalion |
| Fate | Returned to Australia 5 November 1917 |
