| Regimental number | 6996 |
| Place of birth | Charters Towers Queensland |
| Religion | Church of England |
| Occupation | Fruitgrower |
| Address | Dulong, Nambour, Queensland |
| Marital status | Single |
| Age at embarkation | 35 |
| Next of kin | Mother, Mrs M Jorgensen, Dulong, Nambour, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 15th Battalion, 23rd Reinforcement |
| AWM Embarkation Roll number | 23/32/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 15th Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
