| Occupation as written | Domestic duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 13 May 1912 |
| Application status | Approved |
| Official | GB |
| Date of approval or denial | 19 May 1912 |
| If rejected, why? | |
| Birthplace as written | Warsaw, Poland |
| Modern country | Poland |
| Age on application | 45 |
| Age on arrival in Australia | 6 |
| Port of Departure | Poland |
| Port of Arrival | Maryborough |
| Date of arrival | 23 Apr 1873 |
| Name of ship | Humboldt |
| Voyage | Humboldt (1873-06-19) |
| Address in Australia | Bowen Street, Maryborough |
| Address State | Queensland |
| Time at address | 39 years |
| Married | No |
| Children | No |
| Name of reference | Charles Henry Hughes |
| Occupation of reference | Justice of the Peace (Queensland) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |