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REPÚBLICA DE COLOMBIA
Declaración de Importación Privada 500
1. Año 2025
Espacio reservado para la DIAN (Antes de diligenciar este formulario lea cuidadosamente las instrucciones)
4. Número de formulario
032025002185339-1
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
1022943854
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. 116575016449383
43 . Año – Mes – Día
2025 – 12 – 20
44 . Documento de transporte
No. SHAN0452422
45 . Año – Mes – Día
2025 – 12 – 16
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
9104006066
52 . Año – Mes – Día
2025 – 12 – 16
53 . Cod. país
procedencia
855
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.
3.810.99
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
855
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.
127.50
72 . Peso neto kgs. dcms.
117.30
73 . Código
embalaje
YY
74 . No. bultos
1
75 . Subpartidas
1
76 . Cod. unidad
comercial
U
77 . Cantidad dcms.
420.00
78 .Valor FOB
USD
24.409.56
79 . Valor fletes USD
1.138.58 Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92
0.00
93
97.366.907
94
0
95
0
96
0.00
I.V.A.
97
0.00
98
97.366.907
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
0.84
81 . Valor Otros Gastos USD
0
82 . Sumatoria de
fletes, seguros
y otros gastos USD
1.139.42
83 . Ajuste valor USD
0.00
84 . Valor aduana
USD
25.548.98
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: 584653-DECL: 1984163-DO: 893131261251- 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 R
ESOLUCIÓN 5050 DEL 10DE NOVIEMBRE DE 2016. EMITIDO POR LA COMISIÓN DE REGULACIÓN DE COMUNICACIONES (ANEXAMOS CERTIFICADO DE HOMOL
OGACIÓN) // NOS ACOGEMOS: AL DECRETO 0925 DE 2013, MERCANCIA QUE NO REQUIERE REGISTRO DE IMPORTACION.SAMSUNG ELECTRONICS COLOMBIA
S.A. OEA COD. OE0001. . PEDIDOS: 3105409686. ID DELIVERY: 6086204088. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A165MZKDLTC, PRODU
CTO: TELEFONO CELULAR GALAXY A16 5G Duos (CON ACCESORIOS PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: NEGRO, M(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
032025002185339
133. Feha: 202512 17
134 . Levante No. 032025001907261 135 . Fecha
2025 – 12 – 22
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 92032501689845
Fecha presentación 2025-12-17 17:54:44
Valor pagado $0.00
Fecha de Impresión: 2025-12-22 14:33:28
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002185339-1
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
ODELO: SM-A165M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR Y AL DETAL./ /MOBILE,SM-A165M/DS,BLACK,LTC( QTY. 420,00 u )(420,00 PCE
); IMEIS: 350558662705121/352871222705129. 350558662705212/352871222705210. 350558662705238/352871222705236. 350558662705303/3528
71222705301. 350558662705311/352871222705319. 350558662705345/352871222705343. 350558662705360/352871222705368. 350558663242520/3
52871223242528. 350558663242553/352871223242551.350558663243585/352871223243583. 350558663250366/352871223250364. 350558663251372
/352871223251370. 350558663252206/352871223252204. 350558663252305/352871223252303. 350558663252339/352871223252337. 350558663252
461/352871223252469. 350558663252552/352871223252550. 350558663253014/352871223253012. 350558663253113/352871223253111. 350558663
253212/352871223253210. 350558663253394/352871223253392. 350558663253477/352871223253475. 350558663253832/352871223253830. 350558
663253865/352871223253863. 350558663253873/352871223253871. 350558663254194/352871223254192 . 350558663254244/352871223254242. 35
0558663254251/352871223254259. 350558663254491/352871223254499. 350558663254616/352871223254614. 350558663254707/352871223254705.
350558663254749/352871223254747. 350558663254988/352871223254986. 350558663255233/352871223255231. 350558663255241/3528712232552
49. 350558663255753/352871223255751. 350558663255761/352871223255769. 350558663255803/352871223255801. 350558663255910/3528712232
55918. 350558663256850/352871223256858. 350558663256942/352871223256940. 350558663257064/352871223257062. 350558663257155/3528712
23257153. 350558663257213/352871223257211. 350558663257221/352871223257229. 350558663257528/352871223257526. 350558663257742/3528
71223257740. 350558663257791/352871223257799. 350558663257882/352871223257880. 350558663258047/352871223258045. 350558663258146/3
52871223258144. 350558663258351/352871223258359. 350558663258377/352871223258375. 350558663258484/352871223258482. 35055866325851
8/352871223258516. 350558663258849/352871223258847. 350558663258856/352871223258854. 350558663258880/352871223258888. 35055866325
9003/352871223259001. 350558663259334/352871223259332. 350558663259342/352871223259340. 350558663259359/352871223259357.350558663
259367/352871223259365. 350558663259482/352871223259480. 350558663259649/352871223259647. 350558663259672/352871223259670. 350558
663259755/352871223259753. 350558663259912/352871223259910. 350558663260217/352871223260215. 350558663260332/352871223260330. 350
558663260381/352871223260389. 350558663260407/352871223260405. 350558663260522/352871223260520. 350558663260530/352871223260538.
350558663260621/352871223260629. 350558663260894/352871223260892. 350558663260944/352871223260942. 350558663261231/35287122326123
9. 350558663261298/352871223261296.350558663261363/352871223261361. 350558663261819/352871223261817. 350558663261900/352871223261
908. 350558663261934/352871223261932. 350558663261959/352871223261957. 350558663261991/352871223261999. 350558663262114/352871223
262112. 350558663262247/352871223262245. 350558663262262/352871223262260. 350558663262353/352871223262351. 350558663262460/352871
223262468. 350558663263203/352871223263201. 350558663263476/352871223263474. 350558663263526/352871223263524. 350558663263534/352
871223263532. 350558663263542/352871223263540. 350558663263575/352871223263573. 350558663263583/352871223263581. 350558663263716/
352871223263714. 350558663264219/352871223264217. 350558663264342/352871223264340. 350558663264532/352871223264530. 3505586632647
71/352871223264779. 350558663264847/352871223264845. 350558663264870/352871223264878. 350558663264946/352871223264944. 3505586632
65257/352871223265255. 350558663265570/352871223265578. 350558663265695/352871223265693. 350558663265950/352871223265958. 3505586
63266008/352871223266006. 350558663266230/352871223266238. 350558663266289/352871223266287. 350558663266354/352871223266352. 3505
58663266362/352871223266360. 350558663266412/352871223266410. 350558663266446/352871223266444. 350558663266768/352871223266766. 3
50558663266909/352871223266907. 350558663266933/352871223266931. 350558663266958/352871223266956. 350558663267030/352871223267038
. 350558663267113/352871223267111. 350558663267170/352871223267178. 350558663267196/352871223267194. 350558663267204/352871223267
202. 350558663267212/352871223267210. 350558663267220/352871223267228. 350558663267246/352871223267244. 350558663267337/352871223
267335. 350558663267527/352871223267525. 350558663267865/352871223267863. 350558663267899/352871223267897.350558663267931/3528712
23267939. 350558663268053/352871223268051. 350558663268079/352871223268077. 350558663268178/352871223268176. 350558663268269/3528
71223268267. 350558663268277/352871223268275. 350558663268293/352871223268291. 350558663268327/352871223268325. 350558663268608/3
52871223268606. 350558663268798/352871223268796. 350558663268806/352871223268804. 350558663268830/352871223268838. 35055866326884
8/352871223268846. 350558663268897/352871223268895. 350558663268939/352871223268937. 350558663268954/352871223268952. 35055866326
8996/352871223268994.350558663269150/352871223269158. 350558663269168/352871223269166. 350558663269333/352871223269331. 350558663
269382/352871223269380. 350558663269580/352871223269588. 350558663269606/352871223269604. 350558663269614/352871223269612. 350558
663269630/352871223269638. 350558663269697/352871223269695. 350558663269739/352871223269737. 350558663269978/352871223269976. 350
558663270075/352871223270073. 350558663270216/352871223270214. 350558663270265/352871223270263. 350558663270521/352871223270529.
350558663270539/352871223270537. 350558663271230/352871223271238. 350558663271404/352871223271402. 350558663272113/35287122327211
1. 350558663272295/352871223272293. 350558663272733/352871223272731. 350558663272758/352871223272756. 350558663272923/35287122327
2921. 350558663273616/352871223273614. 350558663273657/352871223273655. 350558663273723/352871223273721. 350558663274028/35287122
3274026. 350558663274390/352871223274398. 350558663274721/352871223274729. 350558663274762/352871223274760. 350558663275116/35287
1223275114. 350558663275157/352871223275155. 350558663275215/352871223275213. 350558663275553/352871223275551. 350558663275603/35
2871223275601. 350558663275835/352871223275833. 350558663276130/352871223276138. 350558663276270/352871223276278. 350558663277039
/352871223277037. 350558663277047/352871223277045. 350558663277229/352871223277227. 350558663277542/352871223277540. 350558663277
914/352871223277912. 350558663485590/352871223485598. 350558663485632/352871223485630. 350558663485665/352871223485663. 350558663
485848/352871223485846. 350558663485855/352871223485853. 350558663485913/352871223485911. 350558663485939/352871223485937. 350558
663485970/352871223485978. 350558663486267/352871223486265. 350558663486325/352871223486323.350558663486358/352871223486356. 3505
58663486374/352871223486372. 350558663486390/352871223486398. 350558663486911/352871223486919. 350558663487273/352871223487271. 3
50558663487497/352871223487495. 350558663487596/352871223487594. 350558663487687/352871223487685. 350558663487695/352871223487693
. 350558663487810/352871223487818. 350558663488024/352871223488022. 350558663488107/352871223488105. 350558663488438/352871223488
436. 350558663488669/352871223488667. 350558663488677/352871223488675. 350558663488818/352871223488816. 350558663488917/352871223
488915.350558663489063/352871223489061. 350558663489105/352871223489103. 350558663489154/352871223489152. 350558663489311/3528712
23489319. 350558663489329/352871223489327. 350558663489840/352871223489848. 350558663489956/352871223489954. 350558663489972/3528
71223489970. 350558663490095/352871223490093. 350558663490293/352871223490291. 350558663490509/352871223490507. 350558663490525/3
52871223490523. 350558663490533/352871223490531. 350558663490541/352871223490549. 350558663490566/352871223490564. 35055866349058
2/352871223490580. 350558663490624/352871223490622. 350558663490632/352871223490630. 350558663490665/352871223490663. 35055866349
0723/352871223490721. 350558663490798/352871223490796. 350558663490822/352871223490820. 350558663490996/352871223490994. 35055866
3491085/352871223491083. 350558663491093/352871223491091. 350558663491119/352871223491117. 350558663491135/352871223491133. 35055
8663491184/352871223491182. 350558663491531/352871223491539. 350558663491549/352871223491547. 350558663491556/352871223491554. 35
0558663491648/352871223491646. 350558663491663/352871223491661. 350558663491671/352871223491679. 350558663491879/352871223491877.
350558663491978/352871223491976. 350558663491994/352871223491992. 350558663492000/352871223492008. 350558663492315/3528712234923
13. 350558663492455/352871223492453. 350558663492489/352871223492487. 350558663492521/352871223492529. 350558663492562/3528712234
92560. 350558663492646/352871223492644. 350558663492703/352871223492701. 350558663492745/352871223492743. 350558663492752/3528712
23492750. 350558663492844/352871223492842. 350558663492950/352871223492958. 350558663493024/352871223493022. 350558663493032/3528
71223493030. 350558663493065/352871223493063. 350558663493131/352871223493139.350558663493149/352871223493147. 350558663493164/35
2871223493162. 350558663493206/352871223493204. 350558663493222/352871223493220. 350558663493248/352871223493246. 350558663493255
/352871223493253. 350558663493289/352871223493287. 350558663493370/352871223493378. 350558663493511/352871223493519. 350558663493
578/352871223493576. 350558663493586/352871223493584. 350558663493628/352871223493626. 350558663493693/352871223493691. 350558663
493701/352871223493709. 350558663493750/352871223493758. 350558663493768/352871223493766. 350558663493909/352871223493907.3505586
032025002185339-1
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002185339-1
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
63493982/352871223493980. 350558663494238/352871223494236. 350558663494337/352871223494335. 350558663494493/352871223494491. 3505
58663494568/352871223494566. 350558663494659/352871223494657. 350558663494717/352871223494715. 350558663494857/352871223494855. 3
50558663494998/352871223494996. 350558663495045/352871223495043. 350558663495102/352871223495100. 350558663495110/352871223495118
. 350558663495201/352871223495209. 350558663495318/352871223495316. 350558663495425/352871223495423. 350558663495466/352871223495
464. 350558663495516/352871223495514. 350558663496217/352871223496215. 350558663496373/352871223496371. 350558663496399/352871223
496397. 350558663496514/352871223496512. 350558663496555/352871223496553. 350558663496621/352871223496629. 350558663496639/352871
223496637. 350558663496647/352871223496645. 350558663496654/352871223496652. 350558663496662/352871223496660. 350558663496670/352
871223496678. 350558663496704/352871223496702. 350558663496712/352871223496710. 350558663496738/352871223496736. 350558663501396/
352871223501394. 350558663501404/352871223501402. 350558663501412/352871223501410. 350558663501438/352871223501436. 3505586635014
46/352871223501444. 350558663501461/352871223501469. 350558663501479/352871223501477. 350558663501487/352871223501485. 3505586635
01495/352871223501493. 350558663501503/352871223501501. 350558663501511/352871223501519. 350558663501529/352871223501527. 3505586
63501537/352871223501535. 350558663501552/352871223501550. 350558663501560/352871223501568. 350558663501578/352871223501576. 3505
58663501586/352871223501584. 350558663501594/352871223501592. 350558663501602/352871223501600. 350558663501610/352871223501618. 3
50558663501628/352871223501626. 350558663501636/352871223501634.350558663501644/352871223501642. 350558663501651/352871223501659.
350558663501669/352871223501667. 350558663501677/352871223501675. 350558663501685/352871223501683. 350558663501693/3528712235016
91. 350558663501701/352871223501709. 350558663501719/352871223501717. 350558663501727/352871223501725. 350558663501735/3528712235
01733. 350558663501743/352871223501741. 350558663501750/352871223501758. 350558663501768/352871223501766. 350558663501776/3528712
23501774. 350558663501784/352871223501782. 350558663501792/352871223501790. 350558663501800/352871223501808.350558663501818/35287
1223501816. 350558663501826/352871223501824. 350558663501834/352871223501832. 350558663501842/352871223501840. 350558663501859/35
2871223501857. 350558663501867/352871223501865. 350558663501875/352871223501873. 350558663501883/352871223501881. 350558663501891
/352871223501899. 350558663501909/352871223501907. 350558663501917/352871223501915. 350558663501925/352871223501923. 350558663501
933/352871223501931. 350558663501941/352871223501949. 350558663501958/352871223501956. 350558663501966/352871223501964. 350558663
501974/352871223501972. 350558663501982/352871223501980. 350558663501990/352871223501998. 350558663502006/352871223502004. 350558
663502014/352871223502012. 350558663502022/352871223502020. 350558663502030/352871223502038. 350558663502048/352871223502046. 350
558663502055/352871223502053. 350558663502063/352871223502061. 350558663502089/352871223502087. 350558663502097/352871223502095.
350558663502105/352871223502103. 350558663502113/352871223502111. 350558663502121/352871223502129. 350558663502139/35287122350213
7. 350558663502147/352871223502145. 350558663502154/352871223502152. 350558663502162/352871223502160. 350558663502170/35287122350
2178. 350558663502188/352871223502186. 350558663502196/352871223502194. 350558663502204/352871223502202. 350558663502212/35287122
3502210. 350558663502220/352871223502228. 350558663502238/352871223502236. 350558663502246/352871223502244. 350558663502253/35287
1223502251. 350558663502261/352871223502269. 350558663502279/352871223502277. 350558663502287/352871223502285. 350558663502295/35
2871223502293. 350558663502303/352871223502301. 350558663502311/352871223502319. 350558663502345/352871223502343. 350558663502352
/352871223502350. 350558663502360/352871223502368.350558663502378/352871223502376. 350558663502386/352871223502384. 3505586636437
27/352871223643725. 350558663643735/352871223643733. 350558663683913/352871223683911. 350558663683939/352871223683937. 3505586636
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032025002185339-1
Espacio para uso exclusivo de la Entidad Recaudadora
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