Indiana Code Title 27. Insurance § 27-5.1-3-5

(1) that is on a form prescribed by the commissioner;

(2) that is verified by an affidavit of the:

of the board of the standard company and individuals who are authorized to do business on behalf of the standard company;  and

(3) that reflects the financial condition of the standard company as of the end of the calendar year immediately preceding the date of the annual statement.