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| Issuer | Commonwealth of the Philippines / Provincial Government of Nueva Vizcaya |
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| Year | |
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| Shape | Rectangular |
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| Reverse description | Plain, unprinted off-white paper reverse with a circular violet cancellation stamp at centre reading "OFFICE OF THE PROV. TREASURER" with a handwritten date and the location "Solano, N. Vizcaya". Additional faint handwritten notations appear at upper left. |
| Reverse lettering | OFFICE OF THE PROV. TREASURER Solano, N. Vizcaya |
| Signature(s) | Cirilo Torralba, Demetrio Quirino and Rodrigo Rocha |
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