| Regimental number | 21528 |
| Place of birth | Sydney New South Wales |
| Religion | Church of England |
| Occupation | School teacher |
| Address | Waverley, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs Emily Sams, 'Lancaster', Cross Street, Waverley, New South Wales |
| Enlistment date | 2 October 1917 |
| Rank on enlistment | Sapper |
| Unit name | Signallers, Special Reinforcements |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board A71 Nestor on 28 February 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 5th Divisional Signal Company |
| Fate | Returned to Australia 25 March 1919 |
