| Regimental number | 69050 |
| Place of birth | Melbourne Victoria |
| Religion | Church of England |
| Occupation | Potter |
| Address | 69 Campbell Street, Moreland, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs A M Jacobsen, 69 Campbell Street, Moreland, Victoria |
| Enlistment date | 24 May 1918 |
| Rank on enlistment | Private |
| Unit name | 16th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Carpentaria on 7 November 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
