| Regimental number | 6769 |
| Place of birth | Lincolnshire England |
| Religion | Church of England |
| Occupation | Station |
| Address | Royal Hotel, South, New South Wales |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Mother, Mrs A Jackson, Home Green, Broadstone, Dorset, England |
| Enlistment date | 12 October 1916 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 22nd Reinforcement |
| AWM Embarkation Roll number | 23/19/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT SS Port Nicholson on 8 November 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Motor Transport Company |
| Fate | Effective abroad (still overseas) |
