| Regimental number | 20557 |
| Place of birth | Melbourne Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Gawler, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, C Jacob, Murray Street, Gawler, South Australia |
| Enlistment date | 23 April 1918 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Effective abroad (still overseas) |
