| Regimental number | 5117 |
| Religion | Methodist |
| Occupation | Farmer |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs I K Jackson, Green Bank PO via Logan Village, Queensland |
| Enlistment date | 29 October 1915 |
| Rank on enlistment | Private |
| Unit name | 15th Battalion, 16th Reinforcement |
| AWM Embarkation Roll number | 23/32/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A16 Star Of Victoria on 31 March 1916 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
