| Heading and notes: | Form number E.T. No. 1. Heading is usual Interim period standard format. |
| Message area: | 6 lines of 5 boxes. |
| Reverse side: | Blank. |
| Colours (text & form): | Red on pale yellow. |
| Size of form overall: | 173 × 213 mm. |
| Size of date stamp box: | 33 × 36.5 mm. |
Details of use and rarity.
| Form sub-number |
Schedule number | Earliest recorded date | Rarity rating |
| DO-4A | 87450. | RRR | |
| DO-4B | St 3477 | 18 July 1907 at North Sydney. | RRR |
| DO-4C | St 3477 | 6 October 1908 at Wagga Wagga. | RRR |