| Regimental number | 16754 |
| Place of birth | Perth Western Australia |
| Religion | Church of England |
| Occupation | Student |
| Address | Mundaring Weir, Western Australia |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, Frederick William Jacoby, 191 Thomas Street, Subiaco, Western Australia |
| Enlistment date | 28 July 1916 |
| Rank on enlistment | Sapper |
| Unit name | Divisional Signal Company 4, Reinforcement 9 |
| AWM Embarkation Roll number | 22/14/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A67 Orsova on 12 December 1916 |
| Regimental number from Nominal Roll | Commissioned |
| Rank from Nominal Roll | 2nd Lieutenant |
| Unit from Nominal Roll | Australian Flying Corps |
| Fate | Returned to Australia 24 August 1918 |
