| Regimental number | 2009 |
| Place of birth | Bathurst New South Wales |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Blackheath, New South Wales |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs Harriet S Cousins, Blackheath, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 7th Light Horse Regiment, 14th Reinforcement |
| AWM Embarkation Roll number | 10/12/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A57 Malakuta on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 7th Light Horse Regiment |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
