| Heading and notes: | Form No. E.T. 5 COMMONWEALTH OF AUSTRALIA above POSTMASTER-GENERAL's DEPARTMENT, NEW SOUTH WALES. |
| Message area: | Blue lines and note added vertically at left. |
| Reverse side: | Blank. |
| Colours (text & form): | Blue on cream. |
| Size of form overall: | ??. |
| Size of datestamp box: | ??. |
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| Image kindly supplied by Gary Crocker of Wagga Wagga. The form is thought to have come from the large bonfire lit to destroy "unwanted telegraphic postal material" in the 1990s. |
Details of use and rarity.
| Form sub-number |
Schedule number | Earliest recorded date | Rarity rating |
| PDO-1 | None | 22 December 1922 at Wagga Wagga. | RRRRR |