| Regimental number | 3400 |
| Place of birth | Lancashire England |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Parramatta, New South Wales |
| Marital status | Single |
| Age at embarkation | 29 |
| Next of kin | Father, John Bede Jackson, 46 Park Lane, Swinton Park, England |
| Enlistment date | 17 November 1916 |
| Rank on enlistment | Private |
| Unit name | 54th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/71/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A68 Anchises on 24 January 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Employment Company |
| Fate | Returned to Australia 18 February 1919 |
