| Regimental number | 3410 |
| Place of birth | Copenhagen Denmark |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Queenstown, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs. Margerita Grucob Bay, Estbanegade, Copenhagen, Denmark |
| Enlistment date | 27 March 1917 |
| Rank on enlistment | Private |
| Unit name | 3rd Light Horse Regiment, 29th Reinforcement |
| AWM Embarkation Roll number | 10/8/5 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A17 Port Lincoln on 22 June 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Light Horse Regiment |
| Fate | Discharged 23 May 1919 |
| Miscellaneous details (Nominal Roll) | *Given name Johan Frederick |
