| Regimental number | 22204 |
| Place of birth | Goulburn New South Wales |
| Religion | Church of England |
| Occupation | Blacksmith |
| Address | 15 Hunter street Extended, Newcastle, New South Wales |
| Marital status | Married |
| Age at embarkation | 24 |
| Next of kin | Wife, Mrs D E E Jacobs, Roberts Street, Lindwood, New South Wales |
| Enlistment date | |
| Rank on enlistment | Sapper |
| Unit name | Engineering Field Companies, General Reinforcements |
| AWM Embarkation Roll number | 14/42/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A34 Persic on |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | 4th Divisional Signal Company |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
