| Regimental number | 17781 |
| Place of birth | Ararat Victoria |
| Religion | Congregational |
| Occupation | Fitter and turner |
| Address | Malvern, Victoria |
| Marital status | Single |
| Age at embarkation | 34 |
| Next of kin | Father, David Jack, 50 Ewart Street, Malvern, Victoria |
| Enlistment date | 28 October 1916 |
| Date of enlistment from Nominal Roll | 28 September 1916 |
| Rank on enlistment | Sapper |
| Unit name | March 1917 Reinforcements |
| AWM Embarkation Roll number | 14/42/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A74 Marathon on 10 May 1917 |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | 8th Field Company Engineers |
| Fate | Returned to Australia 17 March 1919 |
