| Regimental number | 61630 |
| Place of birth | Sydenham Victoria |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Sydenham, Victoria |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, W H Jackson, Sydenham, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 12th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A37 Barambah on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 17th Depot Unit of Supply |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
