| Regimental number | 69309 |
| Place of birth | Bergen Norway |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Kerang, Victoria |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Father, H Pedersen, Voorsaa, Denmark |
| Enlistment date | 10 September 1918 |
| Rank on enlistment | Private |
| Unit name | 17th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 2 November 1918 |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
