It certainly looks like it is. There is a difference in this form in that it has a "To" field, which the one above does not. There's also more typing on the left-hand margin.
Looks era appropriate--both in terms of technology employed in production, and aging.
Details such as Rab Butler being Home Sec'y, and being (by a month) the 10th year of QEII's reign are correct.
And, what would possibly be the cause for forging such a mundane object?
So, yeah.
