| Regimental number | 4165 |
| Place of birth | Hebburn-on-Tyne, Durham, England |
| School | Board School of Hebburn-on-Tyne, England |
| Age on arrival in Australia | 20 |
| Religion | Methodist |
| Occupation | Labourer |
| Address | Solomontown, South Australia |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs E Chadwick, 16 McIntyre Street, Hebburn on Tyne, England |
| Previous military service | Served 12 months in Hebburn Territorials. |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 13th Reinforcement |
| AWM Embarkation Roll number | 23/29/4 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A30 Borda on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Died of wounds |
| Place of death or wounding | France |
| Age at death | 24 |
| Age at death from cemetery records | 24 |
| Place of burial | Longuenesse (St. Omer) Souvenir Cemetery (Plot V, Row D, Grave No. 4), France |
| Panel number, Roll of Honour, Australian War Memorial | 67 |
| Miscellaneous information from cemetery records | Parents: James and Elizaabeth SAMPLE, Hebburn-on-Tyne, Northumberland, England |
| Family/military connections | Brother of two others who served and one of whom was also killed. |
| Other details |
War service: Western Front Medals: British War Medal, Victory Medal |