| Heading and notes: | Form number No. 13. Has ELECTRIC TELEGRAPH with crest between words. The Lion and the Unicorn face away from each other in forms A and B. | 
| Message area: | 20 boxes in four lines. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Red on cream. | 
| Size of form overall: | 194 × 223 mm. | 
| Size of date stamp box: | 40 × 34 mm. | 
|  Provenance: Corinphila Sale 320 Dubois Collection Part 3, November 2023 Lot 30194. Johnstone Collection. | SC-DO-4A. Wagga Wagga, NSW to Adelaide Characteristics: 
 The date stamp for TELEGRAPH OFFICE (Type 1) has no date but ADELAIDE across the centre. It is very rare. This form was enclosed in the | 
|  | SC-DO-4B. Melbourne to Heidelberg, Germany repeated at Glenelg. Very early usage of a hand stamp on a telegram. Also earliest recorded example of an Australian telegram crossing the Overland Telegraph line (4 years after opening). Earlier forms with messages transiting the Australian Colonies are included elsewhere elsewhere. A MAJOR FORM IN AUSTRALIA'S TELEGRAPHIC HISTORY. Characteristics: 
 Five early forms from Sydney to Marseilles, France using the Overland Telegraph Line are shown elsewhere. | 
|  | Adelaide to Port Augusta. Very rare T.O date stamp. The message both front and back is completely whited out - unfortunately common with so many South Australian telegrams. Characteristics: 
 | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| DO-4A | None | 20 April 1876 at Adelaide Station. | RRRR | 
| DO-4B | None. | 4 November 1876 at Glenelg. | RRRR | 
| DO-4C | None. | 22 April 1892 at Port Augusta. | RRRR |