| Regimental number | 6755 |
| Place of birth | Kempton Tasmania |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Bridgewater, Tasmania |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs E G Jacques, North Bridgewater, Tasmania |
| Enlistment date | 18 July 1916 |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 22nd Reinforcement |
| AWM Embarkation Roll number | 23/29/4 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A56 Palermo on 30 September 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Returned to Australia 4 January 1919 |
