| Regimental number | 2163 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | Carter |
| Address | 36 Church Street, Parramatta, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs Ellen Jackson, Lansdowne Street, Parramatta, New South Wales |
| Enlistment date | 27 April 1916 |
| Rank on enlistment | Private |
| Unit name | 36th Battalion, 3rd Reinforcement |
| AWM Embarkation Roll number | 23/53/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A68 Anchises on 24 August 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 33rd Battalion |
| Fate | Returned to Australia 30 December 1918 |
