Proof that one is a glorious knight of the new Dynasty of Mohgwyn that the Lord of Blood will inaugurate. Use to be granted audience with Mohg. Only, it is not yet time. For Mohg yet slumbers beside the Divinity. Be Patient. The new dynasty is nigh.

White Mask Varre will give you this item once you have completed the 3 invasions required for his questline to advance. He will give you the Medal after the reusable Bloody Finger, exhausting his dialogue is necessary. This item is used from the inventory. White Mask Varre's advice to not use it just yet is a misdirection. He is awaiting the Mohg Dynasty, which will never come and is a fool's hope (according to Gideon Ofnir) - there is no later prompt to use it. This item is not kept on New Game