| Regimental number | 11992 |
| Place of birth | Redfern New South Wales |
| Religion | Church of England |
| Occupation | Tailor |
| Address | Redfern, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, Samuel Benjamin Jacobs, 153 Abercrombie Street, Redfern, New South Wales |
| Enlistment date | 8 December 1915 |
| Rank on enlistment | Private |
| Unit name | Field Ambulance 9, Section B |
| AWM Embarkation Roll number | 26/52/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A24 Benalla on 1 May 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 9th Field Ambulance |
| Fate | Returned to Australia 2 June 1919 |
