| Date of birth | |
| Place of birth | Painswick England |
| Religion | Church of England |
| Occupation | Medical practitioner |
| Address | North Sydney, New South Wales |
| Marital status | Married |
| Age at embarkation | 38 |
| Next of kin | Wife, Mrs E R M Sampson, Netley Flats, Walker Street, North Sydney, New South Wales |
| Enlistment date | |
| Rank on enlistment | Captain |
| Unit name | Medical Officers |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A74 Marathon on |
| Rank from Nominal Roll | Captain |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Promotions |
Captain Unit: MED Promotion date: |
| Fate | Returned to Australia |