| Regimental number | 36169 |
| Place of birth | Burbanks Western Australia |
| Religion | Church of England |
| Occupation | Labourer |
| Address | 16 Salisbury Street, Subiaco, Western Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, William Jacobs, 16 Salisbury Street, Subiaco, Western Australia |
| Previous military service | 22nd Australian Army Medical Corps |
| Enlistment date | 14 September 1916 |
| Date of enlistment from Nominal Roll | 12 September 1916 |
| Rank on enlistment | Gunner |
| Unit name | Field Artillery Brigade, Reinforcement 28 |
| AWM Embarkation Roll number | 13/128/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A15 Port Sydney on 9 November 1917 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 10th Field Artillery Brigade |
| Fate | Returned to Australia 1 June 1919 |
