| Regimental number | 2194 |
| Place of birth | Gippsland Victoria |
| Religion | Church of England |
| Occupation | Cook |
| Address | Richmond, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Esther Jacks, 63 Barker Street, Richmond, Victoria |
| Enlistment date | 17 October 1916 |
| Rank on enlistment | Private |
| Unit name | 13th Light Horse Regiment, 16th Reinforcement |
| AWM Embarkation Roll number | 10/18/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board RMS Omrah on 17 January 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Artillery Details |
| Fate | Returned to Australia 30 January 1918 |
