| Regimental number | 2500 |
| Place of birth | Mt Templeton South Australia |
| Religion | Methodist |
| Occupation | Labourer |
| Address | 2 Magill Road, Stepney, South Australia |
| Marital status | Single |
| Age at embarkation | 29 |
| Next of kin | Mother, Mrs Annie Jacka, 2 Magill Road, Stepney, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Australian Remount Unit 1, Reinforcement 2 |
| AWM Embarkation Roll number | 28/2/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A19 Afric on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Flying Corps |
| Fate | Returned to Australia |
| Other details | Medals: British War Medal, Victory Medal |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
