| Regimental number | 1849 |
| Place of birth | Farnham New South Wales |
| Religion | Methodist |
| Occupation | Station worker |
| Address | 58 Tupper Street, Marrickville, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Father, William Sampson, 58 Tupper Street, Marrickville, New South Wales |
| Enlistment date | 25 January 1916 |
| Date of enlistment from Nominal Roll | 24 January 1916 |
| Rank on enlistment | Private |
| Unit name | 12th Light Horse Regiment, 10th Reinforcement |
| AWM Embarkation Roll number | 10/17/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board RMS Mongolia on 8 July 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Light Horse Regiment |
| Fate | Returned to Australia 2 September 1916 |
