| Regimental number | 59 |
| Place of birth | Swansea Tasmania |
| Religion | Church of England |
| Occupation | Engineer |
| Address | Richmond, Tasmania |
| Marital status | Married |
| Age at embarkation | 44 |
| Next of kin | Wife, Mrs F H Jack, c/o Mrs Burrell, Southern Cross Hotel, St Peters, Sydney, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 40th Battalion, Army Medical Corps |
| AWM Embarkation Roll number | 23/57/1 |
| Embarkation details | Unit embarked from Hobart, Tasmania, on board HMAT A35 Berrima on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 40th Battalion |
| Fate | Returned to Australia |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |