| Heading and notes: | Form Number E.T. No. 41a. TELEGRAM - URGENT RATE in one line. Four boxed sections. | 
| Message area: | 25 boxes in five lines. | 
| Reverse side: | Advertisements in three columns. | 
| Colours (text & form): | Black on deep pink. | 
| Size of form overall: | 127 × 204 mm. | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| TU-5 | Sch. C425 - 6/1929. | None seen used. | RRRR |