Personal Background Affidavit {17A-37} | Pdf Fpdf Docx | California

 California   Statewide   Board Of Pharmacy 
Personal Background Affidavit {17A-37} | Pdf Fpdf Docx | California

Last updated: 11/7/2022

Personal Background Affidavit {17A-37}

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17A-37, PERSONAL BACKGROUND AFFIDAVIT. This form is completed by each natural person listed on the application/license that has beneficial interest and/or management and control. A California licensed pharmacist, designated representative, designated representative-3PL, or a designated representative-reverser distributor does not need to complete this form unless listed as a natural person on the application. Failure to complete the form and provide the required information may result in the application being considered incomplete. Attach additional sheets of paper, if necessary.

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