| Regimental number | 11962 |
| Place of birth | Kew Victoria |
| Religion | Church of England |
| Occupation | Bootmaker |
| Address | 95 Newry Street, North Fitzroy, Victoria |
| Marital status | Married |
| Age at embarkation | 34 |
| Next of kin | Wife, Mrs L Jacka, 95 Newry Street, North Fitzroy, Victoria |
| Enlistment date | |
| Rank on enlistment | Gunner |
| Unit name | Divisional Ammunition Column 1, Reinforcement 14 |
| AWM Embarkation Roll number | 25/89/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A32 Themistocles on |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 2nd Field Artillery Brigade |
| Recommendations (Medals and Awards) |
Military Medal Refers 29 April 1918. Recommendation date: |
| Fate | Returned to Australia |