| Regimental number | 3066 |
| Place of birth | Clarence River New South Wales |
| Religion | Methodist |
| Occupation | Coal miner |
| Address | Johnston Street, Collie, Western Australia |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Father, D Jackson, 41 Keightley Road, Subiaco, Western Australia |
| Enlistment date | 26 July 1915 |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/28/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A32 Themistocles on 13 September 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 51st Battalion |
| Fate | Returned to Australia 23 May 1917 |
