| Heading and notes: | Form Number 152. COMMONWEALTH OF AUSTRALIA above standard Interim period heading. URGENT TELEGRAM is in a separate box below. |
| Message area: | 30 boxes in six rows of 5. |
| Reverse side: | Blank. |
| Colours (text & form): | Black on pink paper. |
| Size of form overall: | 213 × 211 mm. |
Provenance: Dave Elsmore. |
VI-TU-1. Message to be sent to St. Arnaud. |
Details of use and rarity.
| Form sub-number |
Schedule number | Earliest recorded date | Rarity rating |
| TU-1 | C.667/2.16. - C.808 | Not dated. | RRRR |