| Regimental number | 4228 |
| Place of birth | Bernier Island Western Australia |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Yalup Brook, Wellington District, Western Australia |
| Marital status | Widower |
| Age at embarkation | 41 |
| Next of kin | Mother, Mrs K Jackson, Yalup Brook, Western Australia |
| Enlistment date | 20 September 1915 |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/28/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A30 Borda on 17 January 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Pioneer Battalion |
| Fate | Returned to Australia 13 February 1917 |
