| Regimental number | 4202 |
| Place of birth | Neuborg Denmark |
| Religion | Methodist |
| Occupation | Fireman |
| Address | Lismore, New South Wales |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Father, Mr Hans Madsen, Blendamsgade No 10, Newborg, Denmark |
| Enlistment date | 16 December 1915 |
| Rank on enlistment | Private |
| Unit name | 25th Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/42/3 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT Commonwealth on 28 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 25th Battalion |
| Fate | Returned to Australia 16 March 1919 |
