| Regimental number | 16119 |
| Place of birth | Ballarat Victoria |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | 40 Park Street, South Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs E Jacka, 40 Park Street, South Melbourne, Victoria |
| Enlistment date | 31 December 1915 |
| Rank on enlistment | Gunner |
| Unit name | Field Artillery Brigade 14, Reinforcement 3 |
| AWM Embarkation Roll number | 13/41/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A11 Ascanius on 27 May 1916 |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 12th Field Artillery Brigade |
| Fate | Returned to Australia 2 June 1919 |
