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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
032025001000777-7
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. 116575015613362
43 . Año – Mes – Día
2025 – 05 – 23
44 . Documento de transporte
No. HKG0417414
45 . Año – Mes – Día
2025 – 05 – 19
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
6900364820
52 . Año – Mes – Día
2025 – 05 – 13
53 . Cod. país
procedencia
351
54 . Cod. Modo
Transporte
4
55 . Código de
Bandera
244
56 . Cod. Depto
destino
0
57 . Empresa transportadora
EMIRATES SUCURSAL COLOMBIA
58 . Tasa de cambio $ cvs.
4.196.66
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.
109.00
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
16.462.25
79 . Valor fletes USD
861.10 Concepto % Base Total Liquidado ($) Total a pagar con esta
declaración ($) Total Liquidado (USD)
Arancel
92
0.00
93
72.702.602
94
0
95
0
96
0.00
I.V.A.
97
0.00
98
72.702.602
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
0.57
81 . Valor Otros Gastos USD
0
82 . Sumatoria de
fletes, seguros
y otros gastos USD
861.67
83 . Ajuste valor USD
0.00
84 . Valor aduana
USD
17.323.92
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: 558947-DECL: 1918203-DO: 893112589251- 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: 3089250849. ID DELIVERY: 6082118600. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A055MLGDLTC, PRODU
CTO: TELEFONO CELULAR GALAXY A05 DUOS (CON ACCESORIOSPARA USO Y NORMAL FUNCIONAMIENTO), COLOR: VERDE CLARO,(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
032025001000777
133. Feha: 202505 22
134 . Levante No. 032025000828168 135 . Fecha
2025 – 05 – 26
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 92032503965216
Fecha presentación 2025-05-22 13:42:18
Valor pagado $0.00
Fecha de Impresión: 2025-05-26 12:34:29
Page 1
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025001000777-7
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
MODELO: SM-A055M/DS, USO O DESTINO: PARA LA VENTA AL MAYOR Y AL DETAL/ /MOBILE,SM-A055M/DS,LIGHT GREEN,LTC( QTY. 300,00 u )(300,
00 PCE); IMEIS: 351641247761329/351847827761320. 351641247761816/351847827761817. 351641247762525/351847827762526. 35164124776315
0/351847827763151. 351641247763762/351847827763763. 351641247764125/351847827764126. 351641247764232/351847827764233. 35164124776
5072/351847827765073. 351641247765106/351847827765107. 351641247765221/351847827765222. 351641247765254/351847827765255. 35164124
7765502/351847827765503. 351641247765510/351847827765511. 351641247765726/351847827765727. 351641247766096/351847827766097. 35164
1247766435/351847827766436. 351641247766625/351847827766626. 351641247766922/351847827766923. 351641247767011/351847827767012. 35
1641247767037/351847827767038. 351641247767045/351847827767046. 351641247767060/351847827767061. 351641247767094/351847827767095.
351641247767102/351847827767103. 351641247767110/351847827767111. 351641247767144/351847827 767145. 351641247767169/351847827767
160. 351641247767185/351847827767186. 351641247767219/351847827767210. 351641247767243/351847827767244.351641247767284/3518478277
67285. 351641247767359/351847827767350. 351641247767466/351847827767467. 351641247767482/351847827767483. 351641247767490/3518478
27767491. 351641247767508/351847827767509. 351641247767615/351847827767616. 351641247767656/351847827767657. 351641247767680/3518
47827767681. 351641247767730/351847827767731. 351641247767763/351847827767764. 351641247767797/351847827767798. 351641247767821/3
51847827767822. 351641247767839/351847827767830. 351641247768001/351847827768002. 351641247768027/351847827768028. 35164124776811
8/351847827768119.351641247768134/351847827768135. 351641247768183/351847827768184. 351641247768225/351847827768226. 351641247768
233/351847827768234. 351641247768241/351847827768242. 351641247768258/351847827768259. 351641247768266/351847827768267. 351641247
768282/351847827768283. 351641247768290/351847827768291. 351641247768357/351847827768358. 351641247768373/351847827768374. 351641
247768381/351847827768382. 351641247768399/351847827768390. 351641247768407/351847827768408. 351641247768456/351847827768457. 351
641247768472/351847827768473. 351641247768480/351847827768481. 351641247768506/351847827768507. 351641247768514/351847827768515.
351641247768530/351847827768531. 351641247768548/351847827768549. 351641247768555/351847827768556. 351641247768563/35184782776856
4. 351641247768589/351847827768580. 351641247768613/351847827768614. 351641247768654/351847827768655. 351641247768662/35184782776
8663. 351641247768670/351847827768671. 351641247768720/351847827768721. 351641247768852/351847827768853. 351641247768860/35184782
7768861. 351641247768886/351847827768887. 351641247769074/351847827769075. 351641247769108/351847827769109. 351641247769132/35184
7827769133. 351641247769157/351847827769158. 351641247769165/351847827769166. 351641247769199/351847827769190. 351641247769231/35
1847827769232. 351641247769264/351847827769265. 351641247769405/351847827769406. 351641247769439/351847827769430. 351641247769447
/351847827769448. 351641247769454/351847827769455. 351641247769462/351847827769463. 351641247769520/351847827769521. 351641247769
553/351847827769554. 351641247769603/351847827769604. 351641247769629/351847827769620. 351641247769637/351847827769638. 351641247
769652/351847827769653. 351641247769660/351847827769661. 351641247769686/351847827769687.351641247769702/351847827769703. 3516412
47769710/351847827769711. 351641247769736/351847827769737. 351641247769751/351847827769752. 351641247769785/351847827769786. 3516
41247769801/351847827769802. 351641247769819/351847827769810. 351641247769843/351847827769844. 351641247769850/351847827769851. 3
51641247769868/351847827769869. 351641247769876/351847827769877. 351641247769900/351847827769901. 351641247769926/351847827769927
. 351641247769975/351847827769976. 351641247770007/351847827770008. 351641247770023/351847827770024. 351641247770031/351847827770
032.351641247770049/351847827770040. 351641247770056/351847827770057. 351641247770098/351847827770099. 351641247770130/3518478277
70131. 351641247770163/351847827770164. 351641247770171/351847827770172. 351641247770197/351847827770198. 351641247770213/3518478
27770214. 351641247770239/351847827770230. 351641247770247/351847827770248. 351641247770262/351847827770263. 351641247770312/3518
47827770313. 351641247770320/351847827770321. 351641247770338/351847827770339. 351641247770346/351847827770347. 351641247770361/3
51847827770362. 351641247770387/351847827770388. 351641247770403/351847827770404. 351641247770411/351847827770412. 35164124777043
7/351847827770438. 351641247770445/351847827770446. 351641247770452/351847827770453. 351641247770460/351847827770461. 35164124777
0486/351847827770487. 351641247770494/351847827770495. 351641247770510/351847827770511. 351641247770536/351847827770537. 35164124
7770544/351847827770545. 351641247770569/351847827770560. 351641247770577/351847827770578. 351641247770585/351847827770586. 35164
1247770593/351847827770594. 351641247770627/351847827770628. 351641247770635/351847827770636. 351641247770650/351847827770651. 35
1641247770668/351847827770669. 351641247770692/351847827770693. 351641247770718/351847827770719. 351641247770726/351847827770727.
351641247770734/351847827770735. 351641247770759/351847827770750. 351641247770767/351847827770768. 351641247770791/3518478277707
92. 351641247770809/351847827770800. 351641247770817/351847827770818. 351641247770825/351847827770826. 351641247770833/3518478277
70834. 351641247770841/351847827770842. 351641247770866/351847827770867. 351641247770908/351847827770909. 351641247770916/3518478
27770917. 351641247770940/351847827770941. 351641247770957/351847827770958.351641247770965/351847827770966. 351641247770973/35184
7827770974. 351641247770981/351847827770982. 351641247770999/351847827770990. 351641247771005/351847827771006. 351641247771039/35
1847827771030. 351641247771054/351847827771055. 351641247771062/351847827771063. 351641247771070/351847827771071. 351641247771088
/351847827771089. 351641247771096/351847827771097. 351641247771104/351847827771105. 351641247771120/351847827771121. 351641247771
138/351847827771139. 351641247771146/351847827771147. 351641247771153/351847827771154. 351641247771161/351847827771162.3516412477
71179/351847827771170. 351641247771187/351847827771188. 351641247771195/351847827771196. 351641247771211/351847827771212. 3516412
47771229/351847827771220. 351641247771286/351847827771287. 351641247771302/351847827771303. 351641247771328/351847827771329. 3516
41247771336/351847827771337. 351641247771344/351847827771345. 351641247771369/351847827771360. 351641247771385/351847827771386. 3
51641247771401/351847827771402. 351641247771443/351847827771444. 351641247771476/351847827771477. 351641247771567/351847827771568
. 351641247771575/351847827771576. 351641247771583/351847827771584. 351641247771609/351847827771600. 351641247771617/351847827771
618. 351641247771658/351847827771659. 351641247771666/351847827771667. 351641247771716/351847827771717. 351641247771732/351847827
771733. 351641247771757/351847827771758. 351641247771773/351847827771774. 351641247771831/351847827771832. 351641247771872/351847
827771873. 351641247771880/351847827771881. 351641247771898/351847827771899. 351641247771906/351847827771907. 351641247771914/351
847827771915. 351641247771922/351847827771923. 351641247771930/351847827771931. 351641247771948/351847827771949. 351641247771955/
351847827771956. 351641247771963/351847827771964. 351641247771971/351847827771972. 351641247771989/351847827771980. 3516412477719
97/351847827771998. 351641247772003/351847827772004. 351641247772011/351847827772012. 351641247772029/351847827772020. 3516412477
72037/351847827772038. 351641247772045/351847827772046. 351641247772128/351847827772129. 351641247772136/351847827772137. 3516412
47772144/351847827772145. 351641247772383/351847827772384. 351641247772540/351847827772541. 351641247772565/351847827772566. 3516
41247772581/351847827772582. 351641247772607/351847827772608.351641247772649/351847827772640. 351641247772664/351847827772665. 35
1641247772847/351847827772848. 351641247773019/351847827773010. 351641247773027/351847827773028. 351641247773043/351847827773044.
351641247773050/351847827773051. 351641247773241/351847827773242. 351641247773258/351847827773259. 351641247773316/3518478277733
17. 351641247773324/351847827773325. 351641247773613/351847827773614. 351641247773761/351847827773762. 351641247773779/3518478277
73770. 351641247773787/351847827773788. 351641247773795/351847827773796. 351641247773803/351847827773804.351641247773852/35184782
7773853. 351641247773860/351847827773861. 351641247773878/351847827773879. 351641247773886/351847827773887. 351641247773894/35184
7827773895. 351641247773902/351847827773903. 351641247773910/351847827773911. 351641247773928/351847827773929. 351641247773936/35
1847827773937. 351641247773944/351847827773945. 351641247773951/351847827773952. 351641247773969/351847827773960. 351641247773977
/351847827773978. 351641247773993/351847827773994. 351641247774017/351847827774018. 351641247774041/351847827774042. 351641247774
066/351847827774067. 351641247774116/351847827774117. 351641247774124/351847827774125. 351641247774132/351847827774133. 351641247
774165/351847827774166. 351641247774199/351847827774190. 351641247774215/351847827774216. 351641247774231/351847827774232. 351641
247774272/351847827774273. 351641247774439/351847827774430. 351641247774488/351847827774489. 351641247774561/351847827774562. 351
641247774579/351847827774570. 351641247774587/351847827774588. 351641247774595/351847827774596. 351641247774645/351847827774646.
032025001000777-7
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025001000777-7
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
351641247774660/351847827774661. 351641247774686/351847827774687. 351641247774702/351847827774703. 351641247774736/35184782777473
7. 351641247774744/351847827774745. 351641247774769/351847827774760. 351641247774827/351847827774828. 351641247774850/35184782777
4851. 351641247774983/351847827774984. 351641247775022/351847827775023. 351641247775055/351847827775056XXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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032025001000777-7
Espacio para uso exclusivo de la Entidad Recaudadora
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