| Heading and notes: | Has Australian Post Office heading. | 
| Message area: | Blank. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on cream. | 
| Size of form overall: | 193 × 222 mm. | 
| 
 AA-AD-5Aa: The front and rear covers are blank. Characteristics: 
 
 | 
|  Printed in 1972. | 
 DO-5Ab (left): Delivery advice docket rom a booklet. Envelope enclosing the telegram is shown below. Characteristics: 
 (above): Reverse side of docket - probably left in the letter-box. | 
|  The telegram which was left under the door - still inside its delivery envelope. | |
|  Printed in 1974. | AA-AD-5Bc (at left): Same wording on reverse side. | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| AD-5Aa | O/N. C.3566/67 ... | 15 October 1979 at Coalcliff, WA. | RR (used) | 
| Sch. C. 7896 / 74. | 1 September 1978 at Bulli, NSW | RR (used) |