Surname:
Christian Names:
Date & Place of Birth:
Service Number:
Service Unit:
Date & Place of Enlistment:
Profession prior to Enlistment:
Date of Return to Aust. & Date of Discharge:
Nature of Casualty:
Date KIA:
Place KIA:
Died of Wounds:
Date Died of Wounds:
Place Died of Wounds:
Died of Injuries or disease:
Next of Kin (NOK) Address
Father:
Mother:
Brother(s):
Sister(s):
Other:
Service
Egypt:
Gallipoli:
France:
Other:
Campaign Medals:
Bravery Awards, Citations, MID:
If Died, Plaque & Scroll received by NOK:
Rank:
Kingscote Honour Board
Kingscote Monument
Penneshaw Honour Board
Penneshaw Memorial
KI Connection: