| Regimental number | 17523 |
| Place of birth | Brisbane Queensland |
| Religion | Brethren |
| Occupation | Clerk |
| Address | Paddington, Queensland |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Mother, Mrs M S Jacobsen, Ewart Street, Paddington, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | April 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 14th Field Ambulance |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
