| Regimental number | 5613 |
| Place of birth | Daylesford Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | East Brunswick, Victoria |
| Marital status | Married |
| Age at embarkation | 39 |
| Next of kin | Wife, Mrs R E Sampson, 46 Laura Street, East Brunswick, Victoria |
| Enlistment date | |
| Rank on enlistment | Sapper |
| Unit name | Tunnelling Companies, October 1916, Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on |
| Rank from Nominal Roll | Sapper |
| Unit from Nominal Roll | Tunnelling Companies Reinforcements |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
