Personal Background Affidavit {17A-37}

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. www.FormsWorkflow.com