| Heading and notes: | No form number. Has FORWARDED FORM in heading. New Interim period heading. | 
| Message area: | 50 boxes in ten rows numbered at the left. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on white paper (glossy on both sides). | 
| Size of form overall: | 169 × 212 mm. | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| TO-1 | No form number. | RRRR |