| Regimental number | 5466 |
| Place of birth | Mackay Queensland |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Mackay, Queensland |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs M A Sam Box, 121 PO, Mackay, Queensland |
| Enlistment date | 11 January 1916 |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 17th Reinforcement |
| AWM Embarkation Roll number | 23/29/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Hawkes Bay on 20 April 1916 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Returned to Australia 16 June 1919 |
