| Regimental number | 7721 |
| Place of birth | Manchester, England |
| Other Names | SHAW, Samuel |
| Religion | Church of England |
| Occupation | Farm hand |
| Address | Perth, Western Australia |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Sister, Mrs M H Shaw, 8 Popular Parade Wallace Street Holderness Road, Hull, England |
| Enlistment date | 2 May 1917 |
| Place of enlistment | Blackboy Hill, Western Australia |
| Rank on enlistment | Private |
| Unit name | 11th Battalion, 26th Reinforcement |
| AWM Embarkation Roll number | 23/28/5 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A30 Borda on 29 June 1917 |
| Miscellaneous details (Nominal Roll) | crossed out on N.R. |
| Miscellaneous details | True name: Samuel SHAW |
