| Heading and notes: | Form number E.T No. 4 in top left corner. Has eight spaces to affix stamps. Lower left corner begins Date .... | 
| Message area: | 25 boxes in five lines. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on range paper. | 
| Size of form overall: | 180 × 220 mm. | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| TU-2A | 85646 | RRRR | |
| TU-2B | None | RRRR |