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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
032025002161817-7
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. 116575016430117
43 . Año – Mes – Día
2025 – 12 – 16
44 . Documento de transporte
No. SHAN0445418
45 . Año – Mes – Día
2025 – 12 – 10
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
9103993646
52 . Año – Mes – Día
2025 – 12 – 10
53 . Cod. país
procedencia
855
54 . Cod. Modo
Transporte
4
55 . Código de
Bandera
249
56 . Cod. Depto
destino
0
57 . Empresa transportadora
DHL AERO EXPRESO S A SUCURSAL COLOMBIA
58 . Tasa de cambio $ cvs.
3.757.92
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.
157.50
72 . Peso neto kgs. dcms.
144.90
73 . Código
embalaje
YY
74 . No. bultos
1
75 . Subpartidas
1
76 . Cod. unidad
comercial
U
77 . Cantidad dcms.
500.00
78 .Valor FOB
USD
29.451.67
79 . Valor fletes USD
1.392.30 Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92
0.00
93
115.913.005
94
0
95
0
96
0.00
I.V.A.
97
0.00
98
115.913.005
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
1.02
81 . Valor Otros Gastos USD
0
82 . Sumatoria de
fletes, seguros
y otros gastos USD
1.393.32
83 . Ajuste valor USD
0.00
84 . Valor aduana
USD
30.844.99
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: 584073-DECL: 1982796-DO: 893130728251- 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: 3105409018. ID DELIVERY: 6086096472. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A165MZADLTC, PRODU
CTO: TELEFONO CELULAR GALAXY A16 5G Duos (CON ACCESORIOS PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: GRIS, 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: Después de insp.: levante
No hay declaración posterior
Acta de inspección No.: 032025000143355
Inició: 2025-12-17 11:04:33 Finalizó: 2025-12-17 18:51:00
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025002161817
133. Feha: 202512 13
134 . Levante No. 032025001886068 135 . Fecha
2025 – 12 – 17
Firma funcionario responsable 136 . Nombre DIEGO ARTURO GARZON RIAÑO
137 . C.C. No. 1069259037
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 92032509901418
Fecha presentación 2025-12-13 13:45:38
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 19:39:14
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161817-7
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
DELO: SM-A165M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR Y AL DETAL./ /MOBILE,SM-A165M/DS,GRAY,LTC( QTY. 500,00 u )(500,00 PCE );
IMEIS: 350558662229684/352871222229682. 350558662229692/352871222229690. 350558662229825/352871222229823. 350558662229866/352871
222229864. 350558662229882/352871222229880. 350558662229940/352871222229948. 350558662230187/352871222230185. 350558662230203/352
871222230201. 350558662230252/352871222230250. 350558662230260/352871222230268. 350558662230286/352871222230284. 350558662230336/
352871222230334. 350558662230344/352871222230342. 350558662230435/352871222230433. 350558662230443/352871222230441. 3505586622305
00/352871222230508. 350558662230518/352871222230516. 350558662230583/352871222230581. 350558662230591/352871222230599. 3505586622
30633/352871222230631. 350558662230658/352871222230656. 350558662230682/352871222230680. 350558662230708/352871222230706. 3505586
62230716/352871222230714. 350558662230724/352871222230722. 350558662230732/352871222230730. 350558662230740/352871222230748. 3505
58662230757/352871222230755. 350558662230765/352871222230763. 350558662230781/352871222230789. 350558662230799/352871222230797. 3
50558662230807/352871222230805. 350558662230823/352871222230821. 350558662230831/352871222230839. 350558662230856/352871222230854
. 350558662230864/352871222230862. 350558662231029/352871222231027. 350558662231136/352871222231134. 350558662231201/352871222231
209. 350558662231250/352871222231258. 350558662231276/352871222231274. 350558662231292/352871222231290. 350558662231326/352871222
231324.350558662231383/352871222231381. 350558662231425/352871222231423. 350558662231466/352871222231464. 350558662231474/3528712
22231472. 350558662231490/352871222231498. 350558662231524/352871222231522. 350558662231573/352871222231571. 350558662231581/3528
71222231589. 350558662231623/352871222231621. 350558662231656/352871222231654. 350558662231672/352871222231670. 350558662231680/3
52871222231688. 350558662231698/352871222231696. 350558662231706/352871222231704. 350558662231714/352871222231712. 35055866223172
2/352871222231720. 350558662231730/352871222231738. 350558662231748/352871222231746. 350558662231813/352871222231811. 35055866223
1862/352871222231860. 350558662231870/352871222231878. 350558662231896/352871222231894. 350558662231953/352871222231951. 35055866
2232050/352871222232058. 350558662232076/352871222232074. 350558662232118/352871222232116. 350558662232134/352871222232132. 35055
8662232167/352871222232165. 350558662232241/352871222232249. 350558662232258/352871222232256. 350558662232266/352871222232264. 35
0558662232357/352871222232355. 350558662232456/352871222232454. 350558662232464/352871222232462. 350558662232480/352871222232488.
350558662232514/352871222232512. 350558662232555/352871222232553. 350558662232621/352871222232629. 350558662232704/3528712222327
02. 350558662232712/352871222232710. 350558662232720/352871222232728. 350558662232753/352871222232751. 350558662232803/3528712222
32801. 350558662232894/352871222232892. 350558662232910/352871222232918. 350558662232928/352871222232926. 350558662232985/3528712
22232983. 350558662233017/352871222233015. 350558662233033/352871222233031. 350558662233074/352871222233072. 350558662233165/3528
71222233163. 350558662233173/352871222233171. 350558662233223/352871222233221.350558662233256/352871222233254. 350558662233280/35
2871222233288. 350558662233314/352871222233312. 350558662233421/352871222233429. 350558662233439/352871222233437. 350558662233488
/352871222233486. 350558662233496/352871222233494. 350558662233538/352871222233536. 350558662233553/352871222233551. 350558662233
587/352871222233585. 350558662233611/352871222233619. 350558662233629/352871222233627. 350558662233652/352871222233650. 350558662
233678/352871222233676. 350558662234114/352871222234112. 350558662234171/352871222234179. 350558662234247/352871222234245.3505586
62234288/352871222234286. 350558662234403/352871222234401. 350558662234445/352871222234443. 350558662234452/352871222234450. 3505
58662234460/352871222234468. 350558662234478/352871222234476. 350558662234486/352871222234484. 350558662234528/352871222234526. 3
50558662234551/352871222234559. 350558662234619/352871222234617. 350558662234676/352871222234674. 350558662234759/352871222234757
. 350558662234775/352871222234773. 350558662234858/352871222234856. 350558662234866/352871222234864. 350558662234882/352871222234
880. 350558662234890/352871222234898. 350558662234908/352871222234906. 350558662234916/352871222234914. 350558662234965/352871222
234963. 350558662234973/352871222234971. 350558662235012/352871222235010. 350558662235046/352871222235044. 350558662235103/352871
222235101. 350558662235152/352871222235150. 350558662235285/352871222235283. 350558662235384/352871222235382. 350558662235392/352
871222235390. 350558662235798/352871222235796. 350558662236069/352871222236067. 350558662236085/352871222236083. 350558662236101/
352871222236109. 350558662236150/352871222236158. 350558662236168/352871222236166. 350558662236176/352871222236174. 3505586622361
84/352871222236182. 350558662236218/352871222236216. 350558662236226/352871222236224. 350558662236275/352871222236273. 3505586622
36317/352871222236315. 350558662236325/352871222236323. 350558662236374/352871222236372. 350558662236382/352871222236380. 3505586
62236432/352871222236430. 350558662236440/352871222236448. 350558662236531/352871222236539. 350558662236556/352871222236554. 3505
58662236580/352871222236588. 350558662236598/352871222236596. 350558662236606/352871222236604. 350558662236614/352871222236612. 3
50558662236622/352871222236620. 350558662236630/352871222236638.350558662236655/352871222236653. 350558662236663/352871222236661.
350558662236671/352871222236679. 350558662236705/352871222236703. 350558662236713/352871222236711. 350558662236721/3528712222367
29. 350558662236762/352871222236760. 350558662236788/352871222236786. 350558662236804/352871222236802. 350558662236820/3528712222
36828. 350558662236838/352871222236836. 350558662236846/352871222236844. 350558662236879/352871222236877. 350558662236978/3528712
22236976. 350558662236994/352871222236992. 350558662237000/352871222237008. 350558662237018/352871222237016.350558662237158/35287
1222237156. 350558662237166/352871222237164. 350558662237257/352871222237255. 350558662237349/352871222237347. 350558662237364/35
2871222237362. 350558662237380/352871222237388. 350558662237489/352871222237487. 350558662237620/352871222237628. 350558662237760
/352871222237768. 350558662237901/352871222237909. 350558662237950/352871222237958. 350558662238032/352871222238030. 350558662238
073/352871222238071. 350558662238198/352871222238196. 350558662238461/352871222238469. 350558662238594/352871222238592. 350558662
238628/352871222238626. 350558662238826/352871222238824. 350558662238842/352871222238840. 350558662238875/352871222238873. 350558
662238909/352871222238907. 350558662239220/352871222239228. 350558662239345/352871222239343. 350558662239477/352871222239475. 350
558662239535/352871222239533. 350558662239543/352871222239541. 350558662239865/352871222239863. 350558662239956/352871222239954.
350558662240020/352871222240028. 350558662240194/352871222240192. 350558662240400/352871222240408. 350558662240418/35287122224041
6. 350558662240533/352871222240531. 350558662240582/352871222240580. 350558662240590/352871222240598. 350558662240723/35287122224
0721. 350558662241093/352871222241091. 350558662241135/352871222241133. 350558662241283/352871222241281. 350558662241390/35287122
2241398. 350558662241507/352871222241505. 350558662241523/352871222241521. 350558662241549/352871222241547. 350558662241556/35287
1222241554. 350558662241564/352871222241562. 350558662241648/352871222241646. 350558662241796/352871222241794. 350558662241861/35
2871222241869. 350558662241994/352871222241992. 350558662242018/352871222242016. 350558662242026/352871222242024. 350558662242109
/352871222242107. 350558662242125/352871222242123.350558662242232/352871222242230. 350558662242240/352871222242248. 3505586622422
57/352871222242255. 350558662242299/352871222242297. 350558662242307/352871222242305. 350558662242315/352871222242313. 3505586622
42323/352871222242321. 350558662242430/352871222242438. 350558662242588/352871222242586. 350558662242596/352871222242594. 3505586
62242646/352871222242644. 350558662242679/352871222242677. 350558662242695/352871222242693. 350558662242745/352871222242743. 3505
58662242810/352871222242818. 350558662242836/352871222242834. 350558662242901/352871222242909.350558662242919/352871222242917. 35
0558662242943/352871222242941. 350558662242976/352871222242974. 350558662243123/352871222243121. 350558662243776/352871222243774.
350558662243891/352871222243899. 350558662244527/352871222244525. 350558662244535/352871222244533. 350558662244675/3528712222446
73. 350558662244725/352871222244723. 350558662244741/352871222244749. 350558662244774/352871222244772. 350558662244816/3528712222
44814. 350558662244857/352871222244855. 350558662244873/352871222244871. 350558662245144/352871222245142. 350558662245169/3528712
22245167. 350558662245300/352871222245308. 350558662245318/352871222245316. 350558662245946/352871222245944. 350558662246076/3528
71222246074. 350558662246217/352871222246215. 350558662246654/352871222246652. 350558662246662/352871222246660. 350558662246670/3
52871222246678. 350558662246688/352871222246686. 350558662246696/352871222246694. 350558662246704/352871222246702. 35055866224671
2/352871222246710. 350558662246746/352871222246744. 350558662246894/352871222246892. 350558662247116/352871222247114. 35055866224
7165/352871222247163. 350558662247215/352871222247213. 350558662247231/352871222247239. 350558662247249/352871222247247. 35055866
032025002161817-7
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161817-7
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
2247280/352871222247288. 350558662247298/352871222247296. 350558662247504/352871222247502. 350558662247512/352871222247510. 35055
8662247553/352871222247551. 350558662247595/352871222247593. 350558662247652/352871222247650. 350558662247678/352871222247676. 35
0558662247728/352871222247726. 350558662247736/352871222247734. 350558662247744/352871222247742. 350558662247751/352871222247759.
350558662247769/352871222247767. 350558662247801/352871222247809. 350558662247959/352871222247957. 350558662248015/3528712222480
13. 350558662248247/352871222248245.350558662248262/352871222248260. 350558662249245/352871222249243. 350558662249294/35287122224
9292. 350558662249500/352871222249508. 350558662249534/352871222249532. 350558662249567/352871222249565. 350558662249591/35287122
2249599. 350558662249658/352871222249656. 350558662249732/352871222249730. 350558662250011/352871222250019. 350558662250102/35287
1222250100. 350558662250284/352871222250282. 350558662250292/352871222250290. 350558662250300/352871222250308. 350558662250326/35
2871222250324. 350558662250425/352871222250423. 350558662250516/352871222250514.350558662250524/352871222250522. 350558662250532/
352871222250530. 350558662250573/352871222250571. 350558662250649/352871222250647. 350558662250714/352871222250712. 3505586622508
54/352871222250852. 350558662250979/352871222250977. 350558662251001/352871222251009. 350558662251027/352871222251025. 3505586622
51134/352871222251132. 350558662251142/352871222251140. 350558662251159/352871222251157. 350558662251183/352871222251181. 3505586
62251266/352871222251264. 350558662251290/352871222251298. 350558662251316/352871222251314. 350558662251340/352871222251348. 3505
58662251399/352871222251397. 350558662251522/352871222251520. 350558662251829/352871222251827. 350558662251894/352871222251892. 3
50558662252074/352871222252072. 350558662252116/352871222252114. 350558662252124/352871222252122. 350558662252223/352871222252221
. 350558662252306/352871222252304. 350558662252389/352871222252387. 350558662252413/352871222252411. 350558662252439/352871222252
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252668. 350558662252777/352871222252775. 350558662252835/352871222252833. 350558662252942/352871222252940. 350558662252959/352871
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71222605451. 350558662605529/352871222605527. 350558662605545/352871222605543. 350558662606725/352871222606723XXXXXXXXXXXXXXXXXXX
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032025002161817-7
Espacio para uso exclusivo de la Entidad Recaudadora
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