| Regimental number | 3857 |
| Place of birth | Braidwood New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 2 Regent Street, Newtown, New South Wales |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Father, Mrs M Jackson, 2 Regent Street, Newtown, New South Wales |
| Enlistment date | 22 August 1915 |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/34/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A54 Runic on 20 January 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 17th Battalion |
| Fate | Returned to Australia 9 February 1919 |
