| Occupation as written | Domestic duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 9 May 1904 |
| Application status | Approved |
| Official | A.H. |
| Date of approval or denial | 27 May 1904 |
| If rejected, why? | |
| Birthplace as written | Mordrecght, near Rotterdam, Holland |
| Modern country | Netherlands |
| Age on application | 75 |
| Age on arrival in Australia | 49 |
| Port of Departure | USA |
| Port of Arrival | Melbourne |
| Date of arrival | 15 Jul 1878 |
| Name of ship | Steamer Australia |
| Voyage | Australia (1878-07-15) |
| Address in Australia | Smith Street, Bendigo |
| Address State | Victoria |
| Time at address | 26 years |
| Married | Widow | |
| Children | Yes | 6: two boys and four girls - all deceased. |
| Name of reference | J.R. Hoskins |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |