| Regimental number | 16166 |
| Place of birth | Kilmore Victoria |
| Religion | Church of England |
| Occupation | Motor driver |
| Address | South Melbourne, Victoria |
| Marital status | Married |
| Age at embarkation | 35 |
| Next of kin | Wife, Mrs H J Jack, 226 Albert Road, South Melbourne, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | November 1916 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A20 Hororata on |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | 2nd AMTS |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
