| Regimental number | 21041 |
| Occupation | Labourer |
| Next of kin | Father, Hans Peter Madsen, Te Pahu via Ngaruawahia |
| Rank on embarkation | Rifleman |
| Unit name | New Zealand Expeditionary Force, New Zealand Rifle Brigade, 1915, 10th Reinforcements to 1st Battalion, E Company |
| Embarkation details | Unit embarked from Wellington on board Aparima on |
| Sources | Nominal Roll Vol. 2: Roll 38, p. 29 |