| Regimental number | 10289 |
| Place of birth | Sydney New South Wales |
| Religion | Roman Catholic |
| Occupation | Steward |
| Address | Marrickville, New South Wales |
| Marital status | Married |
| Age at embarkation | 27 |
| Next of kin | Wife, Mrs A Jackson, 87 Edgeware Road, Marrickville, New South Wales |
| Enlistment date | 29 November 1915 |
| Date of enlistment from Nominal Roll | 9 November 1914 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, April 1916 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A40 Ceramic on 14 April 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Field Ambulance |
| Fate | Returned to Australia 9 December 1918 |
