| Regimental number | 10176 |
| Place of birth | Bendigo Victoria |
| Religion | Congregational |
| Occupation | Turner and fitter |
| Address | 149 Russell Street, Quarry Hill, Bendigo, Victoria |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Elizabeth Ann Jorgensen, 149 Russell Street, Quarry Hill, Bendigo, Victoria |
| Previous military service | 67th Infantry |
| Enlistment date | |
| Rank on enlistment | Corporal |
| Unit name | 10th Field Company Engineers |
| AWM Embarkation Roll number | 14/29/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A54 Runic on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
