| Heading and notes: | Form number E.T. No. 10. Standard Interim period heading. | 
| Message area: | 7 faint lines. | 
| Reverse side: | Blank. | 
| Colours (text & form): | Black on grey to light green. | 
| Size of form overall: | 137 × 215 mm (top section only). | 
| Size of datestamp box: | 28 × 32 mm. | 
|  Provenance: Dave Elsmore. | VI-RO-3A. Rialto to St Arnaud Characteristics: 
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|  | VI-RO-3B. Rochester to Telegraph Office Bendigo. Top section (original telegram). 
 
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|  Provenance: Dave Elsmore. | VI-RO-3B. Rialto to St. Arnaud Same Reply Paid form as above but has a very early URGENT TELEGRAM label attached. | 
Details of use and rarity.
| Form sub-number | Schedule number | Earliest recorded date | Rarity rating | 
| RO-3A | None | 5 June 1913 at St. Arnaud. | RRRR if a complete form with two sections. RR if one section used. | 
| RO-3B | None. | 18 April 1916 at Bendigo. |