| Regimental number | 3194 |
| Place of birth | Ballarat Victoria |
| Religion | Church of England |
| Occupation | Medical student |
| Address | Normanby Street, Middle Brighton |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Father, Major William Jackson, Normanby Street, Middle Brighton |
| Previous military service | Melbourne University Rifles |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 6th Field Ambulance, Section A |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A31 Ajana on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 6th Field Ambulance |
| Fate | Returned to Australia |
| Other details |
Medals: 1914-15 Star, British War Medal, Victory Medal |