| Regimental number | 58111 |
| Place of birth | Ebeltoft Denmark |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Poston via Wondai, Queensland |
| Marital status | Single |
| Age at embarkation | 32 |
| Next of kin | Mother, Mrs C Jensen, Ebeltoft, Denmark |
| Enlistment date | 9 July 1918 |
| Rank on enlistment | Private |
| Unit name | 6th (Queensland) Reinforcements |
| AWM Embarkation Roll number | 23/111/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A41 Bakara on 4 September 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 9th Battalion |
| Fate | Returned to Australia 22 July 1919 |
