| Occupation as written | Domestic servant |
| Standardised occupation | DS01: Domestic service - Indoor service |
| Application received | 4 Aug 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 9 Sep 1909 |
| If rejected, why? | |
| Birthplace as written | Paris, France |
| Modern country | France |
| Age on application | 53 |
| Age on arrival in Australia | 34 |
| Port of Departure | London |
| Port of Arrival | Rockhampton, Queensland |
| Date of arrival | 17 Jul 1892 |
| Name of ship | India |
| Voyage | India (1872-07-17) |
| Address in Australia | 44 Glenview Street, Paddington |
| Address State | New South Wales |
| Time at address | 6 years |
| Previous address 1 | Rockhampton |
| Address State | Queensland |
| Time at address | 1 years |
| Married | Widow |
| Children | No |
| Name of reference | Percy Roland Dunn |
| Occupation of reference | Justice of the Peace (New South Wales) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |