| Regimental number | 7166 |
| Place of birth | Flushing HOLLAND |
| Religion | Roman Catholic |
| Occupation | Rigger |
| Address | Anna Bay via Newcastle, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, A Geysen, Flushing, Graat Flushing, Holland |
| Enlistment date | 28 September 1917 |
| Rank on enlistment | Private |
| Unit name | 18th Battalion, 21st Reinforcement |
| AWM Embarkation Roll number | 23/35/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A38 Ulysses on 19 December 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | No 2 Squadron, Australian Flying Corps |
| Fate | Effective abroad (still overseas) |
