| Regimental number | 171 |
| Religion | Church of England |
| Occupation | Warehouseman |
| Address | Blythwood Road, Mitcham, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, Henshaw Jackson, Blythwood Road, Mitcham, South Australia |
| Previous military service | 35th Battery FA |
| Enlistment date | 11 October 1914 |
| Rank on enlistment | Private |
| Unit name | 3rd Field Ambulance, B Squadron |
| AWM Embarkation Roll number | 26/46/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board Transport A7 Medic on 20 October 1914 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
