| Regimental number | 2695 |
| Place of birth | Bourke Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Raymond Street, Sale, Victoria |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Father, P Jacobsen, May Street, Rosettaville, Johannesburg, South Africa |
| Enlistment date | 13 July 1915 |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion, 6th Reinforcement |
| AWM Embarkation Roll number | 23/39/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on 27 October 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 59th Battalion |
| Fate | Returned to Australia 22 July 1919 |
