| Occupation as written | Household duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 5 Nov 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 3 Dec 1909 |
| If rejected, why? | |
| Birthplace as written | Ems, Berne, Switzerland |
| Modern country | Switzerland |
| Age on application | 71 |
| Age on arrival in Australia | 31 |
| Port of Departure | Switzerland |
| Port of Arrival | Williamstown |
| Date of arrival | 1 Apr 1867 |
| Name of ship | Ameria |
| Voyage | America (1867-04-01) |
| Address in Australia | Gruyere, Lilydale District |
| Address State | Victoria |
| Time at address | 30 years |
| Previous address 1 | Geelong |
| Address State | Victoria |
| Time at address | 12 years |
| Married | Yes | |
| Children | Yes | 4: two girls and two boys, all in Gruyere district, Victoria. |
| Name of reference | James Rouget |
| 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 |