| Regimental number | 42111 |
| Occupation | Grocer's assistant |
| Next of kin | Wife, Mrs Myrtle Jacobson, c/o E A Jacobson, Taumarunui |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 24th Reinforcements (1st Draft), E Company |
| Embarkation details | Unit embarked from Wellington on board Devon on |
| Sources | Nominal Roll Vol. 3: Roll 59, p. 14 |