| Regimental number | 6091 |
| Place of birth | Copenhagen Denmark |
| Religion | Roman Catholic |
| Occupation | Farmer |
| Address | Bundaberg, Queensland |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Dorothy Jeppeson, Killcrup, Denmark |
| Enlistment date | 21 September 1916 |
| Rank on enlistment | Private |
| Unit name | 26th Battalion, 17th Reinforcement |
| AWM Embarkation Roll number | 23/43/4 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A75 Marathon on 27 October 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 26th Battalion |
| Fate | Returned to Australia 4 May 1917 |