| Regimental number | 19184 |
| Place of birth | Robe South Australia |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Lucindale, South East, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, W G Jackson, Lucindale, S E, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, September 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Persic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in South Australian Garden of Remembrance |
| Date of death | |
| Place of burial | West Terrace Cemetery |