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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
032025001614595-9
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. 116575016011527
43 . Año – Mes – Día
2025 – 09 – 06
44 . Documento de transporte
No. T61725H03072
45 . Año – Mes – Día
2025 – 09 – 01
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
6900385780
52 . Año – Mes – Día
2025 – 08 – 27
53 . Cod. país
procedencia
215
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.
4.019.09
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.
152.00
72 . Peso neto kgs. dcms.
110.25
73 . Código
embalaje
YY
74 . No. bultos
1
75 . Subpartidas
1
76 . Cod. unidad
comercial
U
77 . Cantidad dcms.
450.00
78 .Valor FOB
USD
79 . Valor fletes USD
Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92 93
93.313.343
94
0
95
0
96
0.00
I.V.A.
97 98
93.313.343
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
81 . Valor Otros Gastos USD
82 . Sumatoria de
fletes, seguros
y otros gastos USD
83 . Ajuste valor USD
84 . Valor aduana
USD
23.217.53
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: 571850-DECL: 1952027-DO: 893121939251- 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. (ANEXAMOS CERTIFICADO DE HOMOLOGACIÓN)/ NOS ACOGEMOS: AL DECRETO 0925 DE 2013, MERCANC
IA QUE NO REQUIERE REGISTRO DEIMPORTACION .SAMSUNG ELECTRONICS COLOMBIA S.A. OEA COD. OE0001. . PEDIDOS: 3097287251. ID DELIVERY:
6084305792. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A075MZKDLTC, PRODUCTO: TELEFONO CELULAR GALAXY A07 LTE DUOS (CON ACCESORIOS
PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: NEGRO, MODELO: SM-A075M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR(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.: 032025000076761
Inició: 2025-09-08 12:22:33 Finalizó: 2025-09-08 19:54:00
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025001614595
133. Feha: 202509 05
134 . Levante No. 032025001364754 135 . Fecha
2025 – 09 – 08
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 92032506946885
Fecha presentación 2025-09-05 20:09:14
Valor pagado $0.00
Fecha de Impresión: 2025-09-08 21:20:48
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025001614595-9
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
Y AL DETAL/ /MOBILE,SM-A075M/DS,BLACK,LTC( QTY. 450,00 u )(450,00 PCE); IMEIS: 352169181189611/354282521189619. 352169181204519/
354282521204517. 352169181205730/354282521205738. 352169181209278/354282521209276. 352169181214237/354282521214235. 3521691812160
75/354282521216073. 352169181216828/354282521216826. 352169181217511/354282521217519. 352169181217990/354282521217998. 3521691812
18774/354282521218772. 352169181218907/354282521218905. 352169181218923/354282521218921. 352169181218964/354282521218962. 3521691
81219004/354282521219002. 352169181219178/354282521219176.352169181219590/354282521219598. 352169181220044/354282521220042. 35216
9181220093/354282521220091. 352169181244697/354282521244695. 352169181297497/354282521297495. 352169181297505/354282521297503. 35
2169181299931/354282521299939. 352169181299964/354282521299962. 352169181300499/354282521300497. 352169181300689/354282521300687.
352169181300721/354282521300729. 352169181302503/354282521302501. 352169181303113/35428252 1303111. 352169181303345/354282521303
343. 352169181303840/354282521303848. 352169181303980/354282521303988. 352169181304590/354282521304598.352169181305068/3542825213
05066. 352169181305118/354282521305116. 352169181305563/354282521305561. 352169181305597/354282521305595. 352169181305837/3542825
21305835. 352169181305878/354282521305876. 352169181306082/354282521306080. 352169181306207/354282521306205. 352169181307171/3542
82521307179. 352169181307312/354282521307310. 352169181307585/354282521307583. 352169181307676/354282521307674. 352169181307692/3
54282521307690. 352169181307759/354282521307757. 352169181308930/354282521308938. 352169181309441/354282521309449. 35216918130952
4/354282521309522. 352169181309771/354282521309779. 352169181309839/354282521309837. 352169181309888/354282521309886. 35216918131
0290/354282521310298. 352169181312502/354282521312500. 352169181313666/354282521313664. 352169181313690/354282521313698. 35216918
1313757/354282521313755. 352169181313765/354282521313763. 352169181313773/354282521313771. 352169181313781/354282521313789. 35216
9181313799/354282521313797. 352169181313807/354282521313805. 352169181313856/354282521313854. 352169181313864/354282521313862. 35
2169181313872/354282521313870. 352169181313914/354282521313912. 352169181314060/354282521314068. 352169181314094/354282521314092.
352169181314433/354282521314431. 352169181314490/354282521314498. 352169181314557/354282521314555. 352169181314805/3542825213148
03. 352169181314821/354282521314829. 352169181315133/354282521315131. 352169181315141/354282521315149. 352169181315158/3542825213
15156. 352169181315182/354282521315180. 352169181315273/354282521315271. 352169181315281/354282521315289. 352169181315299/3542825
21315297. 352169181315307/354282521315305. 352169181315323/354282521315321. 352169181315380/354282521315388. 352169181315398/3542
82521315396. 352169181315448/354282521315446.352169181315455/354282521315453. 352169181315471/354282521315479. 352169181315513/35
4282521315511. 352169181315521/354282521315529. 352169181315539/354282521315537. 352169181315547/354282521315545. 352169181315554
/354282521315552. 352169181315562/354282521315560. 352169181315570/354282521315578. 352169181315596/354282521315594. 352169181315
612/354282521315610. 352169181315620/354282521315628. 352169181315638/354282521315636. 352169181315646/354282521315644. 352169181
315661/354282521315669. 352169181315695/354282521315693. 352169181315711/354282521315719.352169181315745/354282521315743. 3521691
81315752/354282521315750. 352169181315760/354282521315768. 352169181315802/354282521315800. 352169181315828/354282521315826. 3521
69181315844/354282521315842. 352169181315919/354282521315917. 352169181315927/354282521315925. 352169181316016/354282521316014. 3
52169181316024/354282521316022. 352169181316107/354282521316105. 352169181316123/354282521316121. 352169181316149/354282521316147
. 352169181316156/354282521316154. 352169181316206/354282521316204. 352169181316222/354282521316220. 352169181316230/354282521316
238. 352169181316248/354282521316246. 352169181316255/354282521316253. 352169181316289/354282521316287. 352169181316313/354282521
316311. 352169181316347/354282521316345. 352169181316354/354282521316352. 352169181317014/354282521317012. 352169181317071/354282
521317079. 352169181317105/354282521317103. 352169181317121/354282521317129. 352169181317139/354282521317137. 352169181317154/354
282521317152. 352169181317162/354282521317160. 352169181317188/354282521317186. 352169181317196/354282521317194. 352169181317212/
354282521317210. 352169181317246/354282521317244. 352169181317253/354282521317251. 352169181317261/354282521317269. 3521691813172
95/354282521317293. 352169181317311/354282521317319. 352169181317386/354282521317384. 352169181317394/354282521317392. 3521691813
17402/354282521317400. 352169181317428/354282521317426. 352169181317519/354282521317517. 352169181317535/354282521317533. 3521691
81317576/354282521317574. 352169181317642/354282521317640. 352169181317824/354282521317822. 352169181317873/354282521317871. 3521
69181318129/354282521318127. 352169181318269/354282521318267. 352169181318327/354282521318325. 352169181318483/354282521318481. 3
52169181318509/354282521318507.352169181318541/354282521318549. 352169181318715/354282521318713. 352169181318822/354282521318820.
352169181318848/354282521318846. 352169181318871/354282521318879. 352169181318897/354282521318895. 352169181318913/3542825213189
11. 352169181318939/354282521318937. 352169181318954/354282521318952. 352169181318970/354282521318978. 352169181318988/3542825213
18986. 352169181319044/354282521319042. 352169181319093/354282521319091. 352169181319168/354282521319166. 352169181319192/3542825
21319190. 352169181319200/354282521319208. 352169181319234/354282521319232.352169181319242/354282521319240. 352169181319259/35428
2521319257. 352169181319523/354282521319521. 352169181319556/354282521319554. 352169181319564/354282521319562. 352169181319580/35
4282521319588. 352169181319606/354282521319604. 352169181319614/354282521319612. 352169181319671/354282521319679. 352169181319838
/354282521319836. 352169181320042/354282521320040. 352169181320117/354282521320115. 352169181320398/354282521320396. 352169181320
562/354282521320560. 352169181320596/354282521320594. 352169181321016/354282521321014. 352169181321388/354282521321386. 352169181
321412/354282521321410. 352169181321693/354282521321691. 352169181321719/354282521321717. 352169181321743/354282521321741. 352169
181321784/354282521321782. 352169181321875/354282521321873. 352169181321883/354282521321881. 352169181321891/354282521321899. 352
169181321909/354282521321907. 352169181321917/354282521321915. 352169181321925/354282521321923. 352169181321933/354282521321931.
352169181321941/354282521321949. 352169181321958/354282521321956. 352169181321966/354282521321964. 352169181321974/35428252132197
2. 352169181321990/354282521321998. 352169181322006/354282521322004. 352169181322022/354282521322020. 352169181322030/35428252132
2038. 352169181322048/354282521322046. 352169181322055/354282521322053. 352169181322097/354282521322095. 352169181322154/35428252
1322152. 352169181322196/354282521322194. 352169181322212/354282521322210. 352169181322220/354282521322228. 352169181322246/35428
2521322244. 352169181322253/354282521322251. 352169181322287/354282521322285. 352169181322295/354282521322293. 352169181322311/35
4282521322319. 352169181322352/354282521322350. 352169181322378/354282521322376. 352169181322386/354282521322384. 352169181322394
/354282521322392.352169181322402/354282521322400. 352169181322469/354282521322467. 352169181322477/354282521322475. 3521691813224
85/354282521322483. 352169181322790/354282521322798. 352169181322824/354282521322822. 352169181322832/354282521322830. 3521691813
22840/354282521322848. 352169181322857/354282521322855. 352169181322865/354282521322863. 352169181322873/354282521322871. 3521691
81322881/354282521322889. 352169181322899/354282521322897. 352169181322907/354282521322905. 352169181322949/354282521322947. 3521
69181322956/354282521322954. 352169181322972/354282521322970.352169181322980/354282521322988. 352169181322998/354282521322996. 35
2169181323020/354282521323028. 352169181323038/354282521323036. 352169181323053/354282521323051. 352169181323079/354282521323077.
352169181323087/354282521323085. 352169181323111/354282521323119. 352169181323145/354282521323143. 352169181323160/3542825213231
68. 352169181323178/354282521323176. 352169181323186/354282521323184. 352169181323194/354282521323192. 352169181323210/3542825213
23218. 352169181323228/354282521323226. 352169181323236/354282521323234. 352169181323251/354282521323259. 352169181323277/3542825
21323275. 352169181323293/354282521323291. 352169181323319/354282521323317. 352169181323327/354282521323325. 352169181323335/3542
82521323333. 352169181323343/354282521323341. 352169181323350/354282521323358. 352169181323368/354282521323366. 352169181323376/3
54282521323374. 352169181323384/354282521323382. 352169181323400/354282521323408. 352169181323418/354282521323416. 35216918132343
4/354282521323432. 352169181323459/354282521323457. 352169181323467/354282521323465. 352169181323475/354282521323473. 35216918132
3483/354282521323481. 352169181323491/354282521323499. 352169181323509/354282521323507. 352169181323533/354282521323531. 35216918
1323558/354282521323556. 352169181323590/354282521323598. 352169181323608/354282521323606. 352169181323624/354282521323622. 35216
9181323657/354282521323655. 352169181323699/354282521323697. 352169181323715/354282521323713. 352169181323723/354282521323721. 35
2169181323749/354282521323747. 352169181323772/354282521323770. 352169181323798/354282521323796. 352169181323814/354282521323812.
032025001614595-9
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025001614595-9
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
352169181323897/354282521323895. 352169181324002/354282521324000. 352169181324028/354282521324026. 352169181324663/3542825213246
61.352169181324713/354282521324711. 352169181324721/354282521324729. 352169181324739/354282521324737. 352169181324747/35428252132
4745. 352169181324754/354282521324752. 352169181324838/354282521324836. 352169181324879/354282521324877. 352169181324903/35428252
1324901. 352169181324911/354282521324919. 352169181324937/354282521324935. 352169181324945/354282521324943. 352169181324986/35428
2521324984. 352169181324994/354282521324992. 352169181325009/354282521325007. 352169181325017/354282521325015. 352169181325041/35
4282521325049. 352169181325066/354282521325064.352169181325090/354282521325098. 352169181325108/354282521325106. 352169181325124/
354282521325122. 352169181325132/354282521325130. 352169181325140/354282521325148. 352169181325157/354282521325155. 3521691813251
73/354282521325171. 352169181325264/354282521325262. 352169181325272/354282521325270. 352169181325413/354282521325411. 3521691813
25421/354282521325429. 352169181325439/354282521325437. 352169181325447/354282521325445. 352169181325470/354282521325478. 3521691
81325561/354282521325569. 352169181325777/354282521325775. 352169181325785/354282521325783. 352169181325793/354282521325791. 3521
69181325835/354282521325833. 352169181325868/354282521325866. 352169181325926/354282521325924. 352169181325975/354282521325973. 3
52169181326007/354282521326005. 352169181326031/354282521326039. 352169181326114/354282521326112. 352169181326122/354282521326120
. 352169181326155/354282521326153. 352169181326171/354282521326179. 352169181326205/354282521326203. 352169181326296/354282521326
294. 352169181326304/354282521326302. 352169181326312/354282521326310. 352169181326338/354282521326336. 352169181326379/354282521
326377. 352169181326411/354282521326419. 352169181326429/354282521326427. 352169181326452/354282521326450. 352169181326478/354282
521326476. 352169181326494/354282521326492. 352169181326510/354282521326518. 352169181326528/354282521326526. 352169181326544/354
282521326542. 352169181326551/354282521326559. 352169181326577/354282521326575. 352169181326585/354282521326583. 352169181326593/
354282521326591. 352169181326619/354282521326617. 352169181518512/354282521518510. 352169181518645/354282521518643. 3521691815192
88/354282521519286. 352169181519585/354282521519583. 352169181521011/354282521521019. 352169181521607/354282521521605.35216918152
1821/354282521521829. 352169181522183/354282521522181. 352169181523561/354282521523569. 352169181523595/354282521523593. 35216918
1523603/354282521523601. 352169181523728/354282521523726. 352169181523777/354282521523775. 352169181524049/354282521524047. 35216
9181524056/354282521524054. 352169181524296/354282521524294. 352169181524353/354282521524351. 352169181524536/354282521524534. 35
2169181524585/354282521524583. 352169181524783/354282521524781. 352169181524874/354282521524872. 352169181524932/354282521524930.
352169181524940/354282521524948.352169181524965/354282521524963. 352169181524973/354282521524971. 352169181524981/35428252152498
9. 352169181525004/354282521525002. 352169181525020/354282521525028. 352169181525079/354282521525077. 352169181525087/35428252152
5085. 352169181525145/354282521525143. 352169181525152/354282521525150. 352169181525228/354282521525226. 352169181525277/35428252
1525275. 352169181525285/354282521525283. 352169181525293/354282521525291. 352169181525335/354282521525333. 352169181525665/35428
2521525663. 352169181526192/354282521526190. 352169181526234/354282521526232. 352169181608610/354282521608618. 352169181608669/35
4282521608667. 352169181608685/354282521608683. 352169181609162/354282521609160. 352169181609519/354282521609517. 352169181609527
/354282521609525. 352169181609741/354282521609749. 352169181609790/354282521609798. 352169181609808/354282521609806. 352169181609
816/354282521609814. 352169181609824/354282521609822. 352169181609832/354282521609830. 352169181609840/354282521609848. 352169181
609857/354282521609855. 352169181609865/354282521609863. 352169181609873/354282521609871. 352169181609881/354282521609889. 352169
181609899/354282521609897. 352169181609907/354282521609905. 352169181609915/354282521609913. 352169181609923/354282521609921. 352
169181609931/354282521609939. 352169181609949/354282521609947. 352169181609956/354282521609954. 352169181609964/354282521609962.
352169181609972/354282521609970. 352169181609980/354282521609988. 352169181609998/354282521609996. 352169181610004/35428252161000
2. 352169181610012/354282521610010. 352169181610020/354282521610028. 352169181610038/354282521610036. 352169181610046/35428252161
0044. 352169181610053/354282521610051. 352169181610061/354282521610069. 352169181610079/354282521610077.352169181610087/354282521
610085. 352169181610095/354282521610093. 352169181610103/354282521610101. 352169181610111/354282521610119. 352169181610129/354282
521610127. 352169181610137/354282521610135. 352169181610145/354282521610143. 352169181610152/354282521610150. 352169181610160/354
282521610168. 352169181610178/354282521610176. 352169181610186/354282521610184. 352169181610194/354282521610192. 352169181610202/
354282521610200. 352169181610210/354282521610218. 352169181610228/354282521610226XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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032025001614595-9
Espacio para uso exclusivo de la Entidad Recaudadora
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