The obverse: a scene depicting 3 figures (allegories of 3 states: a peasant holding a scythe, a worker with a hammer and a nobleman with a cap in his hands) kneeling in front of Our Lady (sitting on the throne with a child Jesus) and submitting the act of constitution; on the top in the centre - a Piast eagle. Reverse: rectangular plate, surrounded by lictorial rods on the sides, with an inscription: „NA | PAMIĄTKĘ | UCHWALENIA | KONSTY- | TUCJI | 17. MARCA | 1921” (To commemorate the adoption of the Constitution on 17 March 1921).