| Regimental number | 5076 |
| Place of birth | Surrey England |
| Religion | Church of England |
| Occupation | Boundary rider |
| Address | Nanargroe Station, Bookham, via Bowning, New South Wales |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs E Jackson, 201 Albion Street, Surry Hills, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 19th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/36/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A31 Ajana on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 19th Battalion |
| Fate | Returned to Australia |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |