| Regimental number | 1963 |
| Place of birth | Durham England |
| Religion | Church of England |
| Occupation | Enginer |
| Address | c/o Mrs A Jackson, Albany Road, Kelmscott, Western Australia |
| Marital status | Married |
| Age at embarkation | 31 |
| Next of kin | Wife, Mrs Mary Jackson, Armadale, Western Australia |
| Enlistment date | 6 March 1915 |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 5th Reinforcement |
| AWM Embarkation Roll number | 23/29/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A20 Hororata on 26 April 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Returned to Australia 20 October 1915 |
