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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
032024001695834-1
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. 41N0691504
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
6900320570
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: 540120-DECL: 1864249-DO: 893128975241- 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: 3078529134. ID DELIVERY: 6079281292. 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
032024001695834
133. Feha: 202412 03
134 . Levante No. 032024001629122 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 92032409032322
Fecha presentación 2024-12-03 15:20:45
Valor pagado $0.00
Fecha de Impresión: 2024-12-05 14:44:45
Page 1
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032024001695834-1
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: 351641241878418/351847821878419. 351641241878434/351847821878435. 351641241878483/351847821878484. 351641241878566/351847
821878567. 351641241878632/351847821878633. 351641241878715/351847821878716. 351641241878756/351847821878757. 351641241878798/351
847821878799. 351641241878889/351847821878880. 351641241878897/351847821878898. 351641241878947/351847821878948. 351641241878954/
351847821878955. 351641241878988/351847821878989. 351641241879002/351847821879003. 351641241879069/351847821879060. 3516412418790
77/351847821879078. 351641241879085/351847821879086. 351641241879093/351847821879094. 351641241879101/351847821879102. 3516412418
79119/351847821879110. 351641241879218/351847821879219. 351641241879523/351847821879524. 351641241879630/351847821879631. 3516412
41879663/351847821879664. 351641241879671/351847821879672. 351641241879705/351847821879706. 3 51641241879739/351847821879730. 351
641241879796/351847821879797. 351641241879804/351847821879805. 351641241879838/351847821879839. 351641241879846/351847821879847.
351641241879853/351847821879854. 351641241879879/351847821879870. 351641241879895/351847821879896. 351641241879911/35184782187991
2. 351641241879937/351847821879938. 351641241879945/351847821879946. 351641241879952/351847821879953. 351641241879978/35184782187
9979. 351641241879986/351847821879987. 351641241880000/351847821880001. 351641241880026/351847821880027. 351641241880059/35184782
1880050.351641241880075/351847821880076. 351641241880083/351847821880084. 351641241881297/351847821881298. 351641241881479/351847
821881470. 351641241881529/351847821881520. 351641241881594/351847821881595. 351641241881651/351847821881652. 351641241881685/351
847821881686. 351641241881719/351847821881710. 351641241881842/351847821881843. 351641241881867/351847821881868. 351641241882006/
351847821882007. 351641241882014/351847821882015. 351641241882030/351847821882031. 351641241882048/351847821882049. 3516412418820
71/351847821882072. 351641241882097/351847821882098.351641241882162/351847821882163. 351641241882170/351847821882171. 35164124188
2188/351847821882189. 351641241882196/351847821882197. 351641241882212/351847821882213. 351641241882220/351847821882221. 35164124
1882246/351847821882247. 351641241882253/351847821882254. 351641241882295/351847821882296. 351641241882329/351847821882320. 35164
1241882337/351847821882338. 351641241882345/351847821882346. 351641241882352/351847821882353. 351641241882378/351847821882379. 35
1641241882386/351847821882387. 351641241882394/351847821882395. 351641241882402/351847821882403. 351641241882410/351847821882411.
351641241882444/351847821882445. 351641241882451/351847821882452. 351641241882485/351847821882486. 351641241882519/3518478218825
10. 351641241882527/351847821882528. 351641241882543/351847821882544. 351641241882550/351847821882551. 351641241882568/3518478218
82569. 351641241882576/351847821882577. 351641241882592/351847821882593. 351641241882600/351847821882601. 351641241882618/3518478
21882619. 351641241880117/351847821880118. 351641241880141/351847821880142. 351641241880158/351847821880159. 351641241880182/3518
47821880183. 351641241880190/351847821880191. 351641241880216/351847821880217. 351641241880315/351847821880316. 351641241880323/3
51847821880324. 351641241880364/351847821880365. 351641241880455/351847821880456. 351641241880471/351847821880472. 35164124188048
9/351847821880480. 351641241880521/351847821880522. 351641241880539/351847821880530. 351641241880570/351847821880571. 35164124188
0588/351847821880589. 351641241880596/351847821880597. 351641241880612/351847821880613. 351641241880620/351847821880621. 35164124
1880638/351847821880639. 351641241880711/351847821880712. 351641241880802/351847821880803. 351641241880810/351847821880811.351641
241880836/351847821880837. 351641241880844/351847821880845. 351641241880851/351847821880852. 351641241880869/351847821880860. 351
641241880885/351847821880886. 351641241880893/351847821880894. 351641241880919/351847821880910. 351641241880927/351847821880928.
351641241880935/351847821880936. 351641241880976/351847821880977. 351641241880984/351847821880985. 351641241880992/35184782188099
3. 351641241881024/351847821881025. 351641241881057/351847821881058. 351641241881065/351847821881066. 351641241881073/35184782188
1074. 351641241881099/351847821881090.351641241881107/351847821881108. 351641241881115/351847821881116. 351641241881131/351847821
881132. 351641241881156/351847821881157. 351641241881180/351847821881181. 351641241882634/351847821882635. 351641241882642/351847
821882643. 351641241882709/351847821882700. 351641241882725/351847821882726. 351641241882733/351847821882734. 351641241882758/351
847821882759. 351641241882790/351847821882791. 351641241882808/351847821882809. 351641241882824/351847821882825. 351641241882873/
351847821882874. 351641241882931/351847821882932. 351641241882956/351847821882957. 351641241882964/351847821882965. 3516412418829
72/351847821882973. 351641241882980/351847821882981. 351641241882998/351847821882999. 351641241883004/351847821883005. 3516412418
83038/351847821883039. 351641241883046/351847821883047. 351641241883053/351847821883054. 351641241883061/351847821883062. 3516412
41883079/351847821883070. 351641241883087/351847821883088. 351641241883095/351847821883096. 351641241883103/351847821883104. 3516
41241883111/351847821883112. 351641241883129/351847821883120. 351641241883137/351847821883138. 351641241883152/351847821883153. 3
51641241883160/351847821883161. 351641241883178/351847821883179. 351641241883186/351847821883187. 351641241883194/351847821883195
. 351641241883202/351847821883203. 351641241883210/351847821883211. 351641241883228/351847821883229. 351641241883236/351847821883
237. 351641241883244/351847821883245. 351641241883251/351847821883252. 351641241883269/351847821883260. 351641241883277/351847821
883278. 351641241883285/351847821883286. 351641241883293/351847821883294. 351641241883301/351847821883302. 351641241883319/351847
821883310. 351641241883327/351847821883328. 351641241883343/351847821883344. 351641241883350/351847821883351.351641241883376/3518
47821883377. 351641241883384/351847821883385. 351641241883418/351847821883419. 351641241883459/351847821883450. 351641241883483/3
51847821883484. 351641241883509/351847821883500. 351641241883525/351847821883526. 351641241883541/351847821883542. 35164124188364
0/351847821883641. 351641241883665/351847821883666. 351641241883673/351847821883674. 351641241883863/351847821883864. 35164124188
3897/351847821883898. 351641241883988/351847821883989. 351641241883996/351847821883997. 351641241884002/351847821884003. 35164124
1884051/351847821884052.351641241884093/351847821884094. 351641241884101/351847821884102. 351641241884119/351847821884110. 351641
241884143/351847821884144. 351641241884192/351847821884193. 351641241884259/351847821884250. 351641241884309/351847821884300. 351
641241884317/351847821884318. 351641241884325/351847821884326. 351641241884333/351847821884334. 351641241884424/351847821884425.
351641241884465/351847821884466. 351641241884515/351847821884516. 351641241884606/351847821884607. 351641241884648/35184782188464
9. 351641241884671/351847821884672. 351641241884713/351847821884714. 351641241884721/351847821884722. 351641241884812/35184782188
4813. 351641241884820/351847821884821. 351641241884838/351847821884839. 351641241884846/351847821884847. 351641241884853/35184782
1884854. 351641241884861/351847821884862. 351641241884879/351847821884870. 351641241884887/351847821884888. 351641241884895/35184
7821884896. 351641241884903/351847821884904. 351641241884911/351847821884912. 351641241884937/351847821884938. 351641241884945/35
1847821884946. 351641241884952/351847821884953. 351641241884960/351847821884961. 351641241884978/351847821884979. 351641241885009
/351847821885000. 351641241885017/351847821885018. 351641241885025/351847821885026. 351641241885058/351847821885059. 351641241885
066/351847821885067. 351641241885116/351847821885117. 351641241885157/351847821885158. 351641241885199/351847821885190. 351641241
885215/351847821885216. 351641241885405/351847821885406. 351641241886932/351847821886933. 351641241887013/351847821887014. 351641
241887039/351847821887030. 351641241887062/351847821887063. 351641241887070/351847821887071. 351641241887112/351847821887113. 351
641241887138/351847821887139. 351641241887146/351847821887147. 351641241887161/351847821887162.351641241887187/351847821887188. 3
51641241887195/351847821887196. 351641241887203/351847821887204. 351641241887237/351847821887238. 351641241887252/351847821887253
. 351641241887260/351847821887261. 351641241887278/351847821887279. 351641241887286/351847821887287. 351641241887294/351847821887
295. 351641241887302/351847821887303. 351641241887310/351847821887311. 351641241887336/351847821887337. 351641241887344/351847821
887345. 351641241887351/351847821887352. 351641241887369/351847821887360. 351641241887385/351847821887386. 351641241887401/351847
821887402.351641241887419/351847821887410. 351641241887427/351847821887428. 351641241887435/351847821887436. 351641241887443/3518
47821887444. 351641241887450/351847821887451. 351641241887468/351847821887469. 351641241887484/351847821887485. 351641241887492/3
51847821887493. 351641241887500/351847821887501. 351641241887518/351847821887519. 351641241887526/351847821887527. 35164124188754
2/351847821887543. 351641241887559/351847821887550. 351641241887591/351847821887592. 351641241887609/351847821887600. 35164124188
7617/351847821887618. 351641241887625/351847821887626. 351641241887658/351847821887659. 351641241887674/351847821887675. 35164124
032024001695834-1
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032024001695834-1
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
1887682/351847821887683. 351641241887690/351847821887691. 351641241887716/351847821887717. 351641241887740/351847821887741. 35164
1241887773/351847821887774. 351641241887781/351847821887782. 351641241887807/351847821887808. 351641241887831/351847821887832. 35
1641241887849/351847821887840. 351641241887864/351847821887865. 351641241887880/351847821887881XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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032024001695834-1
Espacio para uso exclusivo de la Entidad Recaudadora
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