| Heading and notes: | Form number E. T. No. 10. Has two sections under COMMONWEALTH heading plus a date stamp box. This section occupies about 36% of the form. | 
| Message area: | Blank. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on thick green paper. | 
| Size of form overall: | 138 × 216 mm (top half). | 
| Size of datestamp box: | 25 × 28 mm. | 
|  | NI-RO-5. Calcairn to Yass (10 June 1916). Characteristics: 
 | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| RO-1 | St. 3428. | 10 June 1916 at Yass. | RRR |