| Regimental number | 71663 |
| Occupation | Coachbuilder |
| Next of kin | Wife, Mrs A F Sampson, Ngaruawahia |
| Rank on embarkation | Corporal |
| Unit name | New Zealand Expeditionary Force, 41st Reinforcements, E Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT Ulimaroa on |
| Sources | Nominal Rolls Vol. 4: Roll 87, p. 3 |