| Regimental number | 5712 |
| Place of birth | Gravesend England |
| Religion | Church of England |
| Occupation | Farmers labourer |
| Address | 86 Beach Street, Port Melbourne, Victoria |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Father, Mr W Jackson, 12 Brunswick Road, Gravesend, London, England |
| Enlistment date | 7 March 1916 |
| Rank on enlistment | Private |
| Unit name | 5th Battalion, 17th Reinforcement |
| AWM Embarkation Roll number | 23/22/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A14 Euripides on 4 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Battalion |
| Fate | Returned to Australia 27 July 1917 |
