| Regimental number | 11958 |
| Place of birth | Fryerstown Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Spring Gully, Fryers Town, Victoria |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Father, - Jacobsen, Spring Gully, Fryers Town, Victoria |
| Enlistment date | |
| Rank on enlistment | Gunner |
| Unit name | Divisional Ammunition Column 1, Reinforcement 14 |
| AWM Embarkation Roll number | 25/89/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A32 Themistocles on |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 12th Field Artillery Brigade |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
