| Regimental number | 11296 |
| Place of birth | Australia |
| Occupation | Miner |
| Next of kin | Father, C Jacobson, Wangaratta, Victoria, Australia |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 12th Reinforcements (1st Draft), Otago Infantry Battalion, D Company |
| Embarkation details | Unit embarked from Wellington on board Ulimoroa on |
| Sources | Nominal Roll Vol. 2: Roll 30, p. 13 |