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| 正面描述 | Black letterpress printing on white paper. Central vignette of a mounted soldier in uniform brandishing a sword on horseback, with the numeral 5 repeated at all four corners and along the lateral borders. The denomination in words appears below the central vignette, flanked by the place and date of issue at lower left and right; a four-digit serial number is positioned at lower left, with two manuscript signatures accompanied by printed official titles below. |
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| 正面铭文 | 5 CHEQUE PROVISIONAL DE CIRCULACION FORZOSA EMITIDO CON LA GARANTIA DE LA DEUDA DEL ESTADO, RENTAS FISCALES Y DEPARTAMENTALES IQUITOS, 1º DE OCTUBRE 1921 POR CINCO LIBRAS PERUANAS DE ORO N° 0782 CAP. JEFE POLITICO Y MILITAR ADMOR. DE LA ADUANA (Translation: Provisional check of compelled circulation, issued with the guarantee of the State Debt, Tax and Departmental rents Iquitos October 1st., 1921 For five Libras Peruanas de Oro Captain Political and Military Chief Manager of the Custom House) |
| 背面描述 | Light brown letterpress printing. Central vignette of two soldiers standing at arms with rifles, the numeral 5 repeated at all four corners and along the lateral borders, with the denomination in words printed below the vignette. |
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