| Regimental number | 3608 |
| Place of birth | Pandefjord Norway |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Quairading, Western Australia |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Father, Severin Jacobsen, Marum, Saundefford, Norway |
| Enlistment date | 15 April 1917 |
| Rank on enlistment | Private |
| Unit name | Camel Corps, May 1917 Reinforcements |
| AWM Embarkation Roll number | 11/14/1 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A17 Port Lincoln on 30 June 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 10th Light Horse Regiment |
| Fate | Discharged 20 September 1919 |
