| Regimental number | 22337 |
| Occupation | Railway ganger |
| Next of kin | Wife, Mrs G A Jacobson, 8 Gillies Street, Caversham, Dunedin |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 17th Reinforcements, Otago Infantry Battalion, D Company |
| Embarkation details | Unit embarked from Wellington on board Pakeha on |
| Sources | Nominal Roll Vol. 2: Roll 41, p. 15 |