| Regimental number | 3628 |
| Place of birth | Sydney, New South Wales |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Moore Park, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs A E Jorgensen, 6 Seymour Place, Moore Park, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 41st Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/58/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Ormonde on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 41st Battalion |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Photo: Robert and Sandra Crofts |
| Date of death | |
| Age at death | 28 |
| Place of burial | Rookwood Necropolis (Sec. R.C. 9, 3807), Sydney, New South Wales |
