| Regimental number | 17228 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Tram conductor |
| Address | 81 Bank Street, North Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 28 |
| Next of kin | Wife, Mrs E E Jackson, 81 Bank Street, North Sydney, New South Wales |
| Enlistment date | 17 January 1916 |
| Rank on enlistment | Gunner |
| Unit name | Divisional Ammunition Column 5, Reinforcement 3 |
| AWM Embarkation Roll number | 25/112/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A69 Warilda on 22 May 1916 |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | Australian General Base Depot |
| Fate | Returned to Australia 5 November 1917 |
