| Regimental number | 3907 |
| Religion | Methodist |
| Occupation | Miner |
| Address | Torrington, via Deepwater, New South Wales |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Father, B Sampson, Torrington via Deepwater, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/21/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
