| Regimental number | 6492 |
| Place of birth | Worthwood England, Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 557 Balmain Road, Leichhardt, New South Wales |
| Marital status | Married |
| Age at embarkation | 37 |
| Next of kin | Wife, Mrs F M Dominey, 557 Balmain Road, Leichhardt, New South Wales |
| Enlistment date | 5 January 1916 |
| Rank on enlistment | Private |
| Unit name | 3rd Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/20/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 7 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Battalion |
| Fate | Returned to Australia 18 January 1919 |
