| Regimental number | 58030 |
| Occupation | Carrier |
| Next of kin | Father, J P Jacobson, 14 Victoria Street, Petone, Wellington |
| Rank on embarkation | BS-Major |
| Unit name | New Zealand Expeditionary Force, 43rd Reinforcements (2nd Draft), New Zealand Field Artillery |
| Embarkation details | Unit embarked from Wellington on board HMNZT 111 Matatua on |
| Sources | Nominal Rolls Vol. 4: Roll 90, p. 18 |