| Regimental number | 1049 |
| Place of birth | Bangalow New South Wales |
| Religion | Methodist |
| Occupation | Farm hand |
| Address | Knockrow via Bangalow, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, John Jackson, Knockrow, Bangalow, New South Wales |
| Enlistment date | 24 January 1916 |
| Rank on enlistment | Private |
| Unit name | 41st Battalion, 1st Reinforcement |
| AWM Embarkation Roll number | 23/58/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A64 Demosthenes on 18 May 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 9th Battalion |
| Fate | Returned to Australia 21 December 1918 |
