| Regimental number | 964 |
| Place of birth | Lenvig Denmark |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Gundum, Lemvig, Denmark |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs M D Petersen, Gundum, Lemvig, Denmark |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 5th Light Horse Regiment, 5th Reinforcement |
| AWM Embarkation Roll number | 10/10/2 |
| Embarkation details | Unit embarked from Newcastle, New South Wales, on board HMAT A57 Malakuta on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Light Horse Regiment |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in Queensland Garden of Remembrance |
| Date of death |