| Regimental number | 13353 |
| Place of birth | Ballarat Victoria |
| Religion | Methodist |
| Occupation | Ironmoulder |
| Address | Ballarat, Victoria |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Mother, Mrs M Sampson, 225 Armstrong Street, Ballarat, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A63 Karoola on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Field Ambulance |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
