| Occupation as written | Household Duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 30 Mar 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 3 Apr 1911 |
| If rejected, why? | |
| Birthplace as written | Benchen, Posen, Prussian Poland (Russian Pole German) |
| Modern country | Poland |
| Age on application | 67 |
| Age on arrival in Australia | 48 |
| Port of Departure | England |
| Port of Arrival | Sydney |
| Date of arrival | 14 Mar 1892 |
| Name of ship | Rualine |
| Voyage | Rualine (1892-03-14) |
| Address in Australia | 12 Gertrude St., Windsor |
| Address State | Victoria |
| Time at address |
| Previous address 1 | Hill End |
| Address State | New South Wales |
| Time at address | 2 years |
| Previous address 2 | Melbourne and West Melbourne |
| Address State | Victoria |
| Time at address |
| Married | Yes | |
| Children | Yes | 2: 1 male and 1 female |
| Name of reference | William Tyner |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |