| Regimental number | 3401 |
| Place of birth | Broken Hill New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Barney Street, Kiama, New South Wales |
| Marital status | Married |
| Age at embarkation | 34 |
| Next of kin | Wife, Mrs Lilly Jackson, Barney Street, Kiama, New South Wales |
| Enlistment date | 24 November 1916 |
| Rank on enlistment | Private |
| Unit name | 54th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/71/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A68 Anchises on 24 January 1917 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 54th Battalion |
| Fate | Returned to Australia 11 December 1918 |
