| Regimental number | 2097 |
| Place of birth | Dawson South Australia |
| Religion | Congregational |
| Occupation | Grocer |
| Address | Prospect, South Australia |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Katherine Rebecca Sampson, corner of Beatrice street and Prospect Road, Prospect, South Australia |
| Enlistment date | 18 December 1915 |
| Rank on enlistment | Private |
| Unit name | 43rd Battalion, 3rd Reinforcement |
| AWM Embarkation Roll number | 23/60/2 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A68 Anchises on 28 August 1916 |
| Rank from Nominal Roll | Lieutenant |
| Unit from Nominal Roll | 43rd Battalion |
| Fate | Returned to Australia 4 July 1919 |
