| Regimental number | 15572 |
| Place of birth | South Yarra Victoria |
| Religion | Church of England |
| Occupation | Clerk |
| Address | Windsor, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, J T Jackson, 46 Vine Street, Windsor, Victoria |
| Enlistment date | 13 August 1915 |
| Rank on enlistment | Private |
| Unit name | September 1916 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A17 Port Lincoln on 20 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 13th Field Ambulance |
| Fate | Returned to Australia 15 May 1919 |
