| Regimental number | 30761 |
| Place of birth | Yorkshire England |
| Religion | Church of England |
| Occupation | Miner |
| Address | Bamboo Creek, North West, Western Australia |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Father, T Jackson, Long Riston, near Hull, Yorkshire, England |
| Enlistment date | 11 April 1916 |
| Rank on enlistment | Driver |
| Unit name | Field Artillery Brigade 10, Reinforcement 8 |
| AWM Embarkation Roll number | 13/37/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A20 Hororata on 23 November 1916 |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 3rd Divisional Ammunition Column |
| Fate | Returned to Australia 23 July 1919 |
