| Regimental number | 5004 |
| Place of birth | Rotterdam Holland |
| Religion | Church of England |
| Occupation | Seaman |
| Address | 'Koorawatha', 8 Ramsey Road, Haberfield, New South Wales |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Mother, Mrs Meulen, Massan Street, Brida, Holland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Australian Army Medical Corps, Hospital Transports Staff (No. 1 Hospital Ship, 'Karoola') |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A67 Orsova on |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | No 10 Company, Australian Army Service Corps |
| Fate | Returned to Australia |
| Date of death |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
