| Regimental number | 3502 |
| Place of birth | Coppenhagen Denmark |
| Religion | Church of England |
| Occupation | Labourer |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Cousin, Miss K Jacobs, Peoples Palace Pier Street, Perth, Western Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 23/33/3 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A24 Benalla on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 16th Battalion |
| Recommendations (Medals and Awards) |
Military Medal Recommendation date: |
| Fate | Returned to Australia |
| Medals |
Military Medal Source: 'Commonwealth Gazette' No. 23 Date: |