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REPÚBLICA DE COLOMBIA
Declaración de Importación Privada 500
1. Año 2024
Espacio reservado para la DIAN (Antes de diligenciar este formulario lea cuidadosamente las instrucciones)
4. Número de formulario
032024001695817-4
5 . Número de Identificación Tributaria (NIT)
830028931
6 . DV.
5
11 . Apellidos y nombres o Razón Social
SAMSUNG ELECTRONICS COLOMBIA S.A.
13 . Dirección
CR 7 113 43 OF 607
15 . Teléfono
4870707
12 . Cód. Admón.
03
16 . Cód. Dpto
11
17 . Cód. Ciudad Municipio
001
24 . Número de Identificación Tributaria (NIT)
860536003
25 . DV.
3
26 . Razón social del declarante autorizado
AGENCIA DE ADUANAS ABC REPECEV S.A.S. NIVEL 1
27 . Tipo usuario
26
28 . Cód. usuario
99
29 . Número documento de identificación
102294385
30 . Apellidos y nombres
CARLOS ANDRES ROJAS MATAJUDIOS
31 . Clase
Importador
02
32 . Tipo declaración
Anticipada
33 . Cod.
3
34 .No.Formulario Anterior
XXXXXXXXXXXXXX
35 . Año – Mes – Día
XXXX – XX – XX
36 . Cod. Admón.
XX
37 . Declaración de Exportación
No. XXXXXXXXXXXXXXX
38 . Año – Mes – Día
XXXX – XX – XX
39 . Cod. Admón.
XX
40 . Cod. lugar ingreso
de las mercancías
BOG
41 . Cod. Depósito
99900
42 . Manifiesto de carga
No. 116575015048101
43 . Año – Mes – Día
2024 – 12 – 04
44 . Documento de transporte
No. 41N0691503
45 . Año – Mes – Día
2024 – 11 – 27
46 . Nombre exportador o proveedor en el exterior
SAMSUNG ELECTRONICS CO., LTD
47 . Ciudad
GYEONGGI-DO
48 . Cod.País Exportador
190
49 . Dirección exportador o proveedor en el exterior
129, SAMSUNG-RO, YEONGTONG-GU SUWON 16677
50 . E-mail
010-8705-6749
51 . No. de factura
6900320366
52 . Año – Mes – Día
2024 – 11 – 20
53 . Cod. país
procedencia
351
54 . Cod. Modo
Transporte
4
55 . Código de
Bandera
169
56 . Cod. Depto
destino
0
57 . Empresa transportadora
TAMPA CARGO S.A.S.
58 . Tasa de cambio $ cvs.
4.406.16
S 59 . Subpartida arancelaria
8517130000
60 . Cod.
Complementario
XX
61 . Cod.
Suplementario
XX
62 . Cod. Modalidad
C134
63 . No. cuotas
o meses
XX
64 . Valor cuota USD
XXXX
65 . Periodicidad del
pago de la cuota
XX
66 . Cod. país
de origen
215
67 . Cod. Acuerdo
XXX
68 . Forma de pago
de la importación
01
69 . Tipo de
importación
01
70 . Cod. país
compra
190
71 . Peso bruto kgs. dcms.
110.00
72 . Peso neto kgs. dcms.
81.30
73 . Código
embalaje
YY
74 . No. bultos
1
75 . Subpartidas
1
76 . Cod. unidad
comercial
U
77 . Cantidad dcms.
300.00
78 .Valor FOB
USD
14.423.75
79 . Valor fletes USD
886.60 Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92
0.00
93
67.463.112
94
0
95
0
96
0.00
I.V.A.
97
0.00
98
67.463.112
99
0
100
0
101
0.00
Salvaguardia
102
0.00
103
0
104
0
105
0
106
0.00
Derechos
Compensatorios
107
0.00
108
0
109
0
110
0
111
0.00
Derechos
Antidumping
112
0.00
113
0
114
0
115
0
116
0.00
Sancion
117
0
118
0
119
0
120
0
Rescate
121
0
122
0
123
0
124
0
Total 125
0
126
0.00
80 . Valor Seguros
USD
0.74
81 . Valor Otros Gastos USD
0
82 . Sumatoria de
fletes, seguros
y otros gastos USD
887.34
83 . Ajuste valor USD
0.00
84 . Valor aduana
USD
15.311.09
85 . Código registro
o licencia
X
86 . Número
XXXXXXXXXX
87 .
Cod.
oficina
99
88 . Año
XXXX
89 . Programa No
XXXXXXXXXX
90 . Cód Interno del
Producto
0
91 . Descripción de las mercancías(No inicie la descripción de las mercancías a importar con lo señalado en el arancel de aduanas en la subpartida arancelaria – Incluya marcas, seriales y otros) (Si el campo es insuficiente, continúe al respaldo de este formulario)
NAC: 540116-DECL: 1864248-DO: 893128974241- DECL 1 DE 1.- //NOS ACOGEMOS AL ARTICULO 424 DEL ESTATUTO TRIBUTARIO MODIFICADO POR L
A LEY 1819DEL 29/12/2016 ARTÍCULO 175 NUMERAL 6 (EXCLUSIÓN DEL IVA). // NOS ACOGEMOS AL ARTÍCULO 2.8.3.1 ORDINAL 2.8.3.1.4 DE LA
RESOLUCIÓN 5050 DEL 10 DE NOVIEMBRE DE 2016. EMITIDO POR LA COMISIÓN DE REGULACIÓN DE COMUNICACIONES (ANEXAMOS CERTIFICADO DE HOM
OLOGACIÓN) // NOS ACOGEMOS: AL DECRETO 0925 DE 2013, MERCANCIA QUE NO REQUIERE REGISTRO DE IMPORTACION.SAMSUNG ELECTRONICS COLOMB
IA S.A. OEA COD. OE0001. . PEDIDOS: 3078528790. ID DELIVERY: 6079280879. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A055MZSGLTC, PRO
DUCTO: TELEFONO CELULAR GALAXY A05 DUOS (CON ACCESORIOS PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: PLATA, MO(continúa al respaldo)
127 . Valor pagos anteriores: 0 128 . Recibo oficial de pago anterior No.: XXXXXXXXXXXXXXX 129. Fecha: XXXX XX XX
130 . Espacio reservado DIAN – Actuación aduanera
Estado de levante: Levante automático
No hay declaración posterior
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032024001695817
133. Feha: 202412 03
134 . Levante No. 032024001629061 135 . Fecha
2024 – 12 – 05
Firma funcionario responsable 136 . Nombre
137 . C.C. No.
Firma declarante 997 . Espacio exclusivo para el sello
de la entidad recaudadora
(Fecha efectiva de la transacción)
Coloque el timbre de la máquina
registradora al dorso de este formulario
980 . Pago Total $
0
996 . Espacio para autoadhesivo de la entidad recaudadora
(Número del adhesivo)
SYGA
Autoadhesivo 92032409032132
Fecha presentación 2024-12-03 15:19:38
Valor pagado $0.00
Fecha de Impresión: 2024-12-05 14:40:02
Page 1
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032024001695817-4
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
DELO: SM-A055M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR Y AL DETAL/ /MOBILE,SM-A055M/DS,SILVER,LTC( QTY. 300,00 u )(300,00 PCE);
IMEIS: 351641241879598/351847821879599. 351641241879606/351847821879607. 351641241879614/351847821879615. 351641241879622/351847
821879623. 351641241879648/351847821879649. 351641241879655/351847821879656. 351641241879689/351847821879680. 351641241879697/351
847821879698. 351641241879713/351847821879714. 351641241879747/351847821879748. 351641241879754/351847821879755. 351641241879762/
351847821879763. 351641241879788/351847821879789. 351641241879820/351847821879821. 351641241879929/351847821879920. 3516412418799
60/351847821879961. 351641241879994/351847821879995. 351641241880281/351847821880282. 351641241880513/351847821880514. 3516412418
80554/351847821880555. 351641241881149/351847821881140. 351641241881271/351847821881272. 351641241881339/351847821881330. 3516412
41881347/351847821881348. 351641241881396/351847821881397. 351641241881404/351847821881405. 3 51641241881438/351847821881439. 351
641241881461/351847821881462. 351641241881537/351847821881538. 351641241881545/351847821881546. 351641241881602/351847821881603.
351641241881636/351847821881637. 351641241881669/351847821881660. 351641241881677/351847821881678. 351641241881727/35184782188172
8. 351641241881743/351847821881744. 351641241881768/351847821881769. 351641241881776/351847821881777. 351641241881784/35184782188
1785. 351641241881834/351847821881835. 351641241882113/351847821882114. 351641241882147/351847821882148. 351641241882261/35184782
1882262.351641241882899/351847821882890. 351641241883145/351847821883146. 351641241888128/351847821888129. 351641241888136/351847
821888137. 351641241888169/351847821888160. 351641241888177/351847821888178. 351641241888185/351847821888186. 351641241888219/351
847821888210. 351641241888227/351847821888228. 351641241888235/351847821888236. 351641241888243/351847821888244. 351641241888276/
351847821888277. 351641241888292/351847821888293. 351641241888391/351847821888392. 351641241888409/351847821888400. 3516412418884
17/351847821888418. 351641241888425/351847821888426.351641241888433/351847821888434. 351641241888458/351847821888459. 35164124188
8474/351847821888475. 351641241888482/351847821888483. 351641241888490/351847821888491. 351641241888508/351847821888509. 35164124
1888516/351847821888517. 351641241888524/351847821888525. 351641241888532/351847821888533. 351641241888540/351847821888541. 35164
1241888557/351847821888558. 351641241888565/351847821888566. 351641241888573/351847821888574. 351641241888581/351847821888582. 35
1641241888599/351847821888590. 351641241888607/351847821888608. 351641241888615/351847821888616. 351641241888623/351847821888624.
351641241888631/351847821888632. 351641241888649/351847821888640. 351641241888656/351847821888657. 351641241888664/3518478218886
65. 351641241888672/351847821888673. 351641241888680/351847821888681. 351641241888698/351847821888699. 351641241888706/3518478218
88707. 351641241888714/351847821888715. 351641241888722/351847821888723. 351641241888730/351847821888731. 351641241888748/3518478
21888749. 351641241878525/351847821878526. 351641241878657/351847821878658. 351641241878913/351847821878914. 351641241879127/3518
47821879128. 351641241879143/351847821879144. 351641241879150/351847821879151. 351641241879168/351847821879169. 351641241879176/3
51847821879177. 351641241879200/351847821879201. 351641241879226/351847821879227. 351641241879234/351847821879235. 35164124187924
2/351847821879243. 351641241879259/351847821879250. 351641241879267/351847821879268. 351641241879275/351847821879276. 35164124187
9283/351847821879284. 351641241879291/351847821879292. 351641241879309/351847821879300. 351641241879317/351847821879318. 35164124
1879325/351847821879326. 351641241879333/351847821879334. 351641241879341/351847821879342. 351641241879358/351847821879359.351641
241879366/351847821879367. 351641241879374/351847821879375. 351641241879382/351847821879383. 351641241879390/351847821879391. 351
641241879408/351847821879409. 351641241879416/351847821879417. 351641241879424/351847821879425. 351641241879432/351847821879433.
351641241879440/351847821879441. 351641241879457/351847821879458. 351641241879465/351847821879466. 351641241879473/35184782187947
4. 351641241879481/351847821879482. 351641241879499/351847821879490. 351641241879507/351847821879508. 351641241879515/35184782187
9516. 351641241879531/351847821879532.351641241879549/351847821879540. 351641241879556/351847821879557. 351641241879564/351847821
879565. 351641241879572/351847821879573. 351641241879580/351847821879581. 351641241886528/351847821886529. 351641241886536/351847
821886537. 351641241886544/351847821886545. 351641241886551/351847821886552. 351641241886569/351847821886560. 351641241886577/351
847821886578. 351641241886585/351847821886586. 351641241886593/351847821886594. 351641241886601/351847821886602. 351641241886619/
351847821886610. 351641241886627/351847821886628. 351641241886635/351847821886636. 351641241886643/351847821886644. 3516412418866
50/351847821886651. 351641241886676/351847821886677. 351641241886684/351847821886685. 351641241886692/351847821886693. 3516412418
86700/351847821886701. 351641241886718/351847821886719. 351641241886734/351847821886735. 351641241886759/351847821886750. 3516412
41886767/351847821886768. 351641241886775/351847821886776. 351641241886783/351847821886784. 351641241886791/351847821886792. 3516
41241886809/351847821886800. 351641241886817/351847821886818. 351641241886825/351847821886826. 351641241886833/351847821886834. 3
51641241886841/351847821886842. 351641241886858/351847821886859. 351641241886882/351847821886883. 351641241887047/351847821887048
. 351641241887054/351847821887055. 351641241887229/351847821887220. 351641241887328/351847821887329. 351641241887476/351847821887
477. 351641241887757/351847821887758. 351641241888003/351847821888004. 351641241888052/351847821888053. 351641241888060/351847821
888061. 351641241888078/351847821888079. 351641241888094/351847821888095. 351641241888102/351847821888103. 351641241888110/351847
821888111. 351641241886064/351847821886065. 351641241886072/351847821886073. 351641241886080/351847821886081.351641241886098/3518
47821886099. 351641241886106/351847821886107. 351641241886114/351847821886115. 351641241886122/351847821886123. 351641241886130/3
51847821886131. 351641241886148/351847821886149. 351641241886155/351847821886156. 351641241886163/351847821886164. 35164124188617
1/351847821886172. 351641241886189/351847821886180. 351641241886197/351847821886198. 351641241886205/351847821886206. 35164124188
6213/351847821886214. 351641241886221/351847821886222. 351641241886239/351847821886230. 351641241886247/351847821886248. 35164124
1886254/351847821886255.351641241886262/351847821886263. 351641241886270/351847821886271. 351641241886288/351847821886289. 351641
241886296/351847821886297. 351641241886304/351847821886305. 351641241886312/351847821886313. 351641241886320/351847821886321. 351
641241886338/351847821886339. 351641241886346/351847821886347. 351641241886361/351847821886362. 351641241886379/351847821886370.
351641241886387/351847821886388. 351641241886395/351847821886396. 351641241886403/351847821886404. 351641241886411/35184782188641
2. 351641241886429/351847821886420. 351641241886437/351847821886438. 351641241886445/351847821886446. 351641241886452/35184782188
6453. 351641241886460/351847821886461. 351641241886478/351847821886479. 351641241886486/351847821886487. 351641241886494/35184782
1886495. 351641241886502/351847821886503. 351641241886510/351847821886511. 351641241888755/351847821888756. 351641241888763/35184
7821888764. 351641241888771/351847821888772. 351641241888789/351847821888780. 351641241888797/351847821888798. 351641241888805/35
1847821888806. 351641241888813/351847821888814. 351641241888821/351847821888822. 351641241888839/351847821888830. 351641241888847
/351847821888848. 351641241888854/351847821888855. 351641241888862/351847821888863. 351641241888870/351847821888871. 351641241888
888/351847821888889. 351641241888896/351847821888897. 351641241888904/351847821888905. 351641241888912/351847821888913. 351641241
888920/351847821888921. 351641241888938/351847821888939. 351641241888946/351847821888947. 351641241888953/351847821888954. 351641
241888961/351847821888962. 351641241888979/351847821888970. 351641241888987/351847821888988. 351641241888995/351847821888996. 351
641241889001/351847821889002. 351641241889019/351847821889010. 351641241889027/351847821889028.351641241889035/351847821889036. 3
51641241889043/351847821889044. 351641241883335/351847821883336. 351641241883426/351847821883427. 351641241883855/351847821883856
. 351641241884358/351847821884359. 351641241884366/351847821884367. 351641241884531/351847821884532. 351641241884598/351847821884
599. 351641241885173/351847821885174. 351641241885298/351847821885299. 351641241885462/351847821885463. 351641241885579/351847821
885570. 351641241885595/351847821885596. 351641241885678/351847821885679. 351641241885694/351847821885695. 351641241885710/351847
821885711.351641241885728/351847821885729. 351641241885736/351847821885737. 351641241885751/351847821885752. 351641241885769/3518
47821885760. 351641241885777/351847821885778. 351641241885785/351847821885786. 351641241885793/351847821885794. 351641241885801/3
51847821885802. 351641241885819/351847821885810. 351641241885827/351847821885828. 351641241885835/351847821885836. 35164124188585
0/351847821885851. 351641241885868/351847821885869. 351641241885876/351847821885877. 351641241885884/351847821885885. 35164124188
5892/351847821885893. 351641241885900/351847821885901. 351641241885918/351847821885919. 351641241885926/351847821885927. 35164124
032024001695817-4
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032024001695817-4
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
1885934/351847821885935. 351641241885942/351847821885943. 351641241885959/351847821885950. 351641241885975/351847821885976. 35164
1241885983/351847821885984. 351641241885991/351847821885992. 351641241886007/351847821886008. 351641241886015/351847821886016. 35
1641241886023/351847821886024. 351641241886049/351847821886040. 351641241886056/351847821886057XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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032024001695817-4
Espacio para uso exclusivo de la Entidad Recaudadora
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