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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
032025000852203-3
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. 116575015500812
43 . Año – Mes – Día
2025 – 04 – 24
44 . Documento de transporte
No. SHAN0387348
45 . Año – Mes – Día
2025 – 04 – 17
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
9103414261
52 . Año – Mes – Día
2025 – 04 – 17
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.
4.329.90
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.
93.50
72 . Peso neto kgs. dcms.
57.00
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
28.901.96
79 . Valor fletes USD
835.05 Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92
0.00
93
128.764.515
94
0
95
0
96
0.00
I.V.A.
97
0.00
98
128.764.515
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
1.44
81 . Valor Otros Gastos USD
0
82 . Sumatoria de
fletes, seguros
y otros gastos USD
836.49
83 . Ajuste valor USD
0.00
84 . Valor aduana
USD
29.738.45
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: 555180-DECL: 1908290-DO: 893109950251- 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: 3087885796. ID DELIVERY: 6081548613. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A165MLGGLTC, PRO
DUCTO: TELEFONO CELULAR GALAXY A16 DUOS (CON ACCESORIOS PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: VERDE CLA(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
032025000852203
133. Feha: 202504 23
134 . Levante No. 032025000679882 135 . Fecha
2025 – 04 – 25
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 92032503150749
Fecha presentación 2025-04-23 20:47:27
Valor pagado $0.00
Fecha de Impresión: 2025-04-25 09:53:08
Page 1
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025000852203-3
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
RO, MODELO: SM-A165M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR Y AL DETAL/ /MOBILE,SM-A165M/DS,LIGHT GREEN,LTC( QTY. 300,00 u )(3
00,00 PCE); IMEIS: 352042194277436/356542824277439. 352042194277642/356542824277645. 352042194277717/356542824277710. 35204219427
8012/356542824278015. 352042194278038/356542824278031. 352042194278301/356542824278304. 352042194278343/356542824278346. 35204219
4278640/356542824278643. 352042194278723/356542824278726. 352042194278806/356542824278809. 352042194278905/356542824278908. 35204
2194278913/356542824278916. 352042194279085/356542824279088.352042194279705/356542824279708. 352042194279721/356542824279724. 352
042194279739/356542824279732. 352042194279812/356542824279815. 352042194280067/356542824280060. 352042194280083/356542824280086.
352042194280117/356542824280110. 352042194280133/356542824280136. 352042194280174/356542824280177. 352042194280265/35654282428026
8. 352042194280315/356542824280318. 352042194280349/356542824280342. 352042194280372/3565428 24280375. 352042194280406/3565428242
80409. 352042194280414/356542824280417. 352042194280729/356542824280722. 352042194280745/356542824280748. 352042194280760/3565428
24280763. 352042194280778/356542824280771. 352042194280794/356542824280797. 352042194280828/356542824280821. 352042194280869/3565
42824280862. 352042194281420/356542824281423. 352042194281438/356542824281431. 352042194281461/356542824281464. 352042194281479/3
56542824281472. 352042194281529/356542824281522. 352042194281743/356542824281746. 352042194281826/356542824281829. 35204219428184
2/356542824281845. 352042194281990/356542824281993. 352042194289654/356542824289657. 352042194289688/356542824289681. 35204219428
9704/356542824289707. 352042194289738/356542824289731. 352042194289829/356542824289822. 352042194289936/356542824289939. 35204219
4289969/356542824289962. 352042194289977/356542824289970. 352042194290025/356542824290028. 352042194290231/356542824290234. 35204
2194290264/356542824290267. 352042194290777/356542824290770. 352042194290785/356542824290788. 352042194290793/356542824290796. 35
2042194290835/356542824290838. 352042194290843/356542824290846. 352042194290884/356542824290887. 352042194290892/356542824290895.
352042194290926/356542824290929. 352042194291007/356542824291000. 352042194291023/356542824291026. 352042194291056/3565428242910
59.352042194291064/356542824291067. 352042194291098/356542824291091. 352042194291106/356542824291109. 352042194291114/35654282429
1117. 352042194291213/356542824291216. 352042194291221/356542824291224. 352042194291254/356542824291257. 352042194291262/35654282
4291265. 352042194291395/356542824291398. 352042194291452/356542824291455. 352042194291478/356542824291471. 352042194291486/35654
2824291489. 352042194291494/356542824291497. 352042194291635/356542824291638. 352042194291775/356542824291778. 352042194291791/35
6542824291794. 352042194291809/356542824291802.352042194291825/356542824291828. 352042194291858/356542824291851. 352042194291924/
356542824291927. 352042194291940/356542824291943. 352042194292013/356542824292016. 352042194282022/356542824282025. 3520421942820
71/356542824282074. 352042194282154/356542824282157. 352042194282162/356542824282165. 352042194282337/356542824282330. 3520421942
82352/356542824282355. 352042194282741/356542824282744. 352042194282824/356542824282827. 352042194282840/356542824282843. 3520421
94283715/356542824283718. 352042194283723/356542824283726. 352042194283764/356542824283767. 352042194284010/356542824284013. 3520
42194284028/356542824284021. 352042194284580/356542824284583. 352042194284994/356542824284997. 352042194285223/356542824285226. 3
52042194285256/356542824285259. 352042194285355/356542824285358. 352042194285488/356542824285481. 352042194286163/356542824286166
. 352042194286254/356542824286257. 352042194286312/356542824286315. 352042194286494/356542824286497. 352042194287039/356542824287
032. 352042194287203/356542824287206. 352042194288052/356542824288055. 352042194288102/356542824288105. 352042194288292/356542824
288295. 352042194288318/356542824288311. 352042194288334/356542824288337. 352042194288359/356542824288352. 352042194288383/356542
824288386. 352042194288433/356542824288436. 352042194288458/356542824288451. 352042194288482/356542824288485. 352042194288490/356
542824288493. 352042194288508/356542824288501. 352042194289019/356542824289012. 352042194289233/356542824289236. 352042194289258/
356542824289251. 352042194289274/356542824289277. 352042194289357/356542824289350. 352042194289381/356542824289384. 3520421942894
31/356542824289434. 352042194294001/356542824294004. 352042194294100/356542824294103. 352042194294183/356542824294186.35204219429
4191/356542824294194. 352042194294381/356542824294384. 352042194294563/356542824294566. 352042194294597/356542824294590. 35204219
4294720/356542824294723. 352042194294779/356542824294772. 352042194294829/356542824294822. 352042194294951/356542824294954. 35204
2194294985/356542824294988. 352042194295008/356542824295001. 352042194295065/356542824295068. 352042194295123/356542824295126. 35
2042194295131/356542824295134. 352042194295149/356542824295142. 352042194295198/356542824295191. 352042194295206/356542824295209.
352042194295230/356542824295233.352042194295255/356542824295258. 352042194296048/356542824296041. 352042194296055/35654282429605
8. 352042194296063/356542824296066. 352042194296097/356542824296090. 352042194296139/356542824296132. 352042194296170/35654282429
6173. 352042194296360/356542824296363. 352042194296402/356542824296405. 352042194296428/356542824296421. 352042194296444/35654282
4296447. 352042194296493/356542824296496. 352042194296550/356542824296553. 352042194296568/356542824296561. 352042194296600/35654
2824296603. 352042194296675/356542824296678. 352042194296774/356542824296777. 352042194296808/356542824296801. 352042194296832/35
6542824296835. 352042194296840/356542824296843. 352042194296857/356542824296850. 352042194296899/356542824296892. 352042194296964
/356542824296967. 352042194296998/356542824296991. 352042194297004/356542824297007. 352042194297020/356542824297023. 352042194297
061/356542824297064. 352042194297228/356542824297221. 352042194297475/356542824297478. 352042194297491/356542824297494. 352042194
297715/356542824297718. 352042194297806/356542824297809. 352042194297897/356542824297890. 352042194298184/356542824298187. 352042
194298200/356542824298203. 352042194298291/356542824298294. 352042194298531/356542824298534. 352042194298754/356542824298757. 352
042194298788/356542824298781. 352042194298812/356542824298815. 352042194298895/356542824298898. 352042194298903/356542824298906.
352042194298911/356542824298914. 352042194298937/356542824298930. 352042194298994/356542824298997. 352042194299133/35654282429913
6. 352042194299216/356542824299219. 352042194299562/356542824299565. 352042194299638/356542824299631. 352042194299729/35654282429
9722. 352042194299786/356542824299789. 352042194299919/356542824299912. 352042194299950/356542824299953.352042194300071/356542824
300074. 352042194300089/356542824300082. 352042194300238/356542824300231. 352042194300261/356542824300264. 352042194300337/356542
824300330. 352042194300352/356542824300355. 352042194300592/356542824300595. 352042194300659/356542824300652. 352042194300683/356
542824300686. 352042194300832/356542824300835. 352042194300915/356542824300918. 352042194300949/356542824300942. 352042194301053/
356542824301056. 352042194301129/356542824301122. 352042194301186/356542824301189. 352042194301392/356542824301395. 3520421943014
18/356542824301411.352042194301509/356542824301502. 352042194301525/356542824301528. 352042194301681/356542824301684. 35204219430
1715/356542824301718. 352042194301764/356542824301767. 352042194301772/356542824301775. 352042194302358/356542824302351. 35204219
4302366/356542824302369. 352042194302374/356542824302377. 352042194302382/356542824302385. 352042194302531/356542824302534. 35204
2194302549/356542824302542. 352042194302572/356542824302575. 352042194302630/356542824302633. 352042194302648/356542824302641. 35
2042194302655/356542824302658. 352042194302663/356542824302666. 352042194302697/356542824302690. 352042194302713/356542824302716.
352042194302739/356542824302732. 352042194302747/356542824302740. 352042194302762/356542824302765. 352042194302796/3565428243027
99. 352042194302804/356542824302807. 352042194302812/356542824302815. 352042194302820/356542824302823. 352042194303216/3565428243
03219. 352042194303232/356542824303235. 352042194350670/356542824350673. 352042194350712/356542824350715. 352042194350720/3565428
24350723. 352042194350746/356542824350749. 352042194292047/356542824292040. 352042194292062/356542824292065. 352042194292070/3565
42824292073. 352042194292088/356542824292081. 352042194292096/356542824292099. 352042194292237/356542824292230. 352042194292260/3
56542824292263. 352042194292336/356542824292339. 352042194292377/356542824292370. 352042194292385/356542824292388. 35204219429243
5/356542824292438. 352042194292468/356542824292461. 352042194292492/356542824292495. 352042194292534/356542824292537. 35204219429
2542/356542824292545. 352042194292567/356542824292560. 352042194292583/356542824292586. 352042194292609/356542824292602. 35204219
4292716/356542824292719. 352042194292807/356542824292800. 352042194292823/356542824292826.352042194292906/356542824292909. 352042
194292997/356542824292990. 352042194293003/356542824293006. 352042194293011/356542824293014. 352042194293029/356542824293022. 352
042194293045/356542824293048. 352042194293052/356542824293055. 352042194293185/356542824293188. 352042194293300/356542824293303.
352042194293334/356542824293337. 352042194293342/356542824293345. 352042194293367/356542824293360. 352042194293599/35654282429359
032025000852203-3
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025000852203-3
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
2. 352042194293623/356542824293626. 352042194293631/356542824293634. 352042194293649/356542824293642. 352042194293664/35654282429
3667.352042194293680/356542824293683. 352042194293714/356542824293717. 352042194293763/356542824293766. 352042194293789/356542824
293782. 352042194293813/356542824293816. 352042194293839/356542824293832. 352042194293987/356542824293980XXXXXXXXXXXXXXXXXXXXXXXX
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032025000852203-3
Espacio para uso exclusivo de la Entidad Recaudadora
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