| Regimental number | 172 |
| Place of birth | Belfast, Ireland |
| Religion | Church of England |
| Occupation | Groom |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs Hilda Black, 'Kia Ora', Pacific Street, Watson Bay, New South Wales |
| Enlistment date | 13 October 1914 |
| Place of enlistment | Rosehill, New South Wales |
| Rank on enlistment | Private |
| Unit name | 7th Light Horse Regiment, A Squadron |
| AWM Embarkation Roll number | 10/12/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A33 Ayrshire on 20 December 1914 |
| Fate | No details of fate entered on Nominal Roll |
| Sources | NAA: B2455, BLACK Samuel Axon |
