| Regimental number | 6757 |
| Place of birth | Hay New South Wales |
| Religion | Methodist |
| Occupation | Grocer |
| Address | Lamorna, Hay, New South Wales |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Father, J. Jacka, Lamorna, Hay, New South Wales |
| Enlistment date | 24 May 1916 |
| Rank on enlistment | Private |
| Unit name | 1st Battalion, 22nd Reinforcement |
| AWM Embarkation Roll number | 23/18/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT SS Port Nicholson on 8 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Battalion |
| Fate | Returned to Australia 21 December 1917 |
