| Heading and notes: | Form number E.T. No. 3. Heading changed to RECEIVED TELEGRAM/ With Prepaid Reply Voucher. Base of form is serrated where the voucher had been. | 
| Message area: | Blank. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on brown. | 
| Size of form overall: | 135 × 205 mm. | 
|  | AB-RO-4. South Beach to Victoria Park, WA Top section of form only. Characteristics: 
 | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| RO-4 | Not on top half. | 18 November 1927 at Tamworth (H). | RRR |