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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
032025002156746-2
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. SHAN0445408
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
9103993632
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: 583959-DECL: 1982619-DO: 893130718251- 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: 3105398198. ID DELIVERY: 6086096957. 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: Después de insp.: levante
No hay declaración posterior
Acta de inspección No.: 032025000143366
Inició: 2025-12-17 10:50:49 Finalizó: 2025-12-17 19:04:00
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025002156746
133. Feha: 202512 12
134 . Levante No. 032025001886106 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 92032509873651
Fecha presentación 2025-12-12 14:24:26
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 19:36:47
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002156746-2
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. 500,00 u )(500,00 PCE
); IMEIS: 350558662265621/352871222265629. 350558662265795/352871222265793. 350558662265845/352871222265843. 350558662265878/3528
71222265876. 350558662265985/352871222265983. 350558662265993/352871222265991. 350558662266066/352871222266064. 350558662266215/3
52871222266213. 350558662266272/352871222266270.350558662266280/352871222266288. 350558662266298/352871222266296. 350558662266777
/352871222266775. 350558662266918/352871222266916. 350558662266934/352871222266932. 350558662266975/352871222266973. 350558662267
031/352871222267039. 350558662267189/352871222267187. 350558662267429/352871222267427. 350558662267551/352871222267559. 350558662
268096/352871222268094. 350558662268187/352871222268185. 350558662268211/352871222268219. 350558662268302/352871222268300. 350558
662268310/352871222268318. 350558662268336/352871222268334. 350558662268344/352871222268342 . 350558662268351/352871222268359. 35
0558662268419/352871222268417. 350558662268450/352871222268458. 350558662268468/352871222268466. 350558662268476/352871222268474.
350558662268484/352871222268482. 350558662268500/352871222268508. 350558662268526/352871222268524. 350558662268534/3528712222685
32. 350558662268542/352871222268540. 350558662268559/352871222268557. 350558662269086/352871222269084. 350558662269276/3528712222
69274. 350558662269557/352871222269555. 350558662269565/352871222269563. 350558662269748/352871222269746. 350558662269904/3528712
22269902. 350558662269995/352871222269993. 350558662270134/352871222270132. 350558662270175/352871222270173. 350558662270209/3528
71222270207. 350558662270290/352871222270298. 350558662271413/352871222271411. 350558662271660/352871222271668. 350558662272403/3
52871222272401. 350558662272478/352871222272476. 350558662272700/352871222272708. 350558662273096/352871222273094. 35055866227359
1/352871222273599. 350558662340218/352871222340216. 350558662340374/352871222340372. 350558662340440/352871222340448. 35055866234
0648/352871222340646. 350558662340853/352871222340851. 350558662341026/352871222341024. 350558662341075/352871222341073.350558662
341125/352871222341123. 350558662341190/352871222341198. 350558662341273/352871222341271. 350558662341554/352871222341552. 350558
662342131/352871222342139. 350558662342156/352871222342154. 350558662342404/352871222342402. 350558662342412/352871222342410. 350
558662342420/352871222342428. 350558662342503/352871222342501. 350558662342628/352871222342626. 350558662342685/352871222342683.
350558662342693/352871222342691. 350558662342917/352871222342915. 350558662342925/352871222342923. 350558662343170/35287122234317
8. 350558662343196/352871222343194.350558662343345/352871222343343. 350558662343410/352871222343418. 350558662343451/352871222343
459. 350558662343519/352871222343517. 350558662343576/352871222343574. 350558662343832/352871222343830. 350558662343998/352871222
343996. 350558662344020/352871222344028. 350558662344152/352871222344150. 350558662344277/352871222344275. 350558662344368/352871
222344366. 350558662344384/352871222344382. 350558662344392/352871222344390. 350558662344608/352871222344606. 350558662344624/352
871222344622. 350558662344665/352871222344663. 350558662344681/352871222344689. 350558662344699/352871222344697. 350558662344715/
352871222344713. 350558662344756/352871222344754. 350558662344764/352871222344762. 350558662346181/352871222346189. 3505586623463
71/352871222346379. 350558662346629/352871222346627. 350558662346645/352871222346643. 350558662346652/352871222346650. 3505586623
46702/352871222346700. 350558662346710/352871222346718. 350558662346736/352871222346734. 350558662346744/352871222346742. 3505586
62346751/352871222346759. 350558662346777/352871222346775. 350558662346785/352871222346783. 350558662346827/352871222346825. 3505
58662346843/352871222346841. 350558662346918/352871222346916. 350558662346942/352871222346940. 350558662346959/352871222346957. 3
50558662346975/352871222346973. 350558662346983/352871222346981. 350558662346991/352871222346999. 350558662347007/352871222347005
. 350558662347015/352871222347013. 350558662347072/352871222347070. 350558662347130/352871222347138. 350558662347148/352871222347
146. 350558662347221/352871222347229. 350558662347239/352871222347237. 350558662347254/352871222347252. 350558662347262/352871222
347260. 350558662347288/352871222347286. 350558662347296/352871222347294. 350558662347353/352871222347351.350558662347429/3528712
22347427. 350558662347486/352871222347484. 350558662347494/352871222347492. 350558662347510/352871222347518. 350558662347544/3528
71222347542. 350558662347577/352871222347575. 350558662347593/352871222347591. 350558662347635/352871222347633. 350558662347643/3
52871222347641. 350558662347650/352871222347658. 350558662347668/352871222347666. 350558662347692/352871222347690. 35055866234770
0/352871222347708. 350558662347726/352871222347724. 350558662347734/352871222347732. 350558662347775/352871222347773. 35055866234
7866/352871222347864.350558662347882/352871222347880. 350558662347890/352871222347898. 350558662347908/352871222347906. 350558662
347965/352871222347963. 350558662347981/352871222347989. 350558662348021/352871222348029. 350558662348088/352871222348086. 350558
662348104/352871222348102. 350558662348484/352871222348482. 350558662348492/352871222348490. 350558662348500/352871222348508. 350
558662348518/352871222348516. 350558662348658/352871222348656. 350558662350191/352871222350199. 350558662355166/352871222355164.
350558662355299/352871222355297. 350558662355489/352871222355487. 350558662355596/352871222355594. 350558662355653/35287122235565
1. 350558662355745/352871222355743. 350558662355752/352871222355750. 350558662356214/352871222356212. 350558662356354/35287122235
6352. 350558662356362/352871222356360. 350558662356388/352871222356386. 350558662356404/352871222356402. 350558662356529/35287122
2356527. 350558662356537/352871222356535. 350558662356545/352871222356543. 350558662356867/352871222356865. 350558662356883/35287
1222356881. 350558662356891/352871222356899. 350558662356909/352871222356907. 350558662356933/352871222356931. 350558662356941/35
2871222356949. 350558662356974/352871222356972. 350558662356982/352871222356980. 350558662357014/352871222357012. 350558662357139
/352871222357137. 350558662357725/352871222357723. 350558662357741/352871222357749. 350558662357816/352871222357814. 350558662357
840/352871222357848. 350558662358087/352871222358085. 350558662358178/352871222358176. 350558662358343/352871222358341. 350558662
358350/352871222358358. 350558662358384/352871222358382. 350558662358442/352871222358440. 350558662358863/352871222358861. 350558
662358913/352871222358911. 350558662359440/352871222359448. 350558662359572/352871222359570.350558662359598/352871222359596. 3505
58662359606/352871222359604. 350558662359754/352871222359752. 350558662359853/352871222359851. 350558662359879/352871222359877. 3
50558662359887/352871222359885. 350558662359952/352871222359950. 350558662360083/352871222360081. 350558662360190/352871222360198
. 350558662360315/352871222360313. 350558662360497/352871222360495. 350558662361156/352871222361154. 350558662361347/352871222361
345. 350558662361503/352871222361501. 350558662361529/352871222361527. 350558662361875/352871222361873. 350558662361925/352871222
361923.350558662361941/352871222361949. 350558662362725/352871222362723. 350558662362907/352871222362905. 350558662362915/3528712
22362913. 350558662363210/352871222363218. 350558662363509/352871222363507. 350558662363624/352871222363622. 350558662363657/3528
71222363655. 350558662363673/352871222363671. 350558662363681/352871222363689. 350558662363699/352871222363697. 350558662363715/3
52871222363713. 350558662363798/352871222363796. 350558662363855/352871222363853. 350558662363889/352871222363887. 35055866236389
7/352871222363895. 350558662363905/352871222363903. 350558662363996/352871222363994. 350558662364002/352871222364000. 35055866236
4143/352871222364141. 350558662364234/352871222364232. 350558662364762/352871222364760. 350558662364770/352871222364778. 35055866
2364838/352871222364836. 350558662364994/352871222364992. 350558662365009/352871222365007. 350558662365041/352871222365049. 35055
8662365082/352871222365080. 350558662365249/352871222365247. 350558662365256/352871222365254. 350558662365298/352871222365296. 35
0558662365504/352871222365502. 350558662365512/352871222365510. 350558662365579/352871222365577. 350558662365603/352871222365601.
350558662365660/352871222365668. 350558662365686/352871222365684. 350558662365694/352871222365692. 350558662365710/3528712223657
18. 350558662365736/352871222365734. 350558662365793/352871222365791. 350558662365942/352871222365940. 350558662366791/3528712223
66799. 350558662366924/352871222366922. 350558662367070/352871222367078. 350558662367088/352871222367086. 350558662367096/3528712
22367094. 350558662367187/352871222367185. 350558662367526/352871222367524. 350558662368086/352871222368084. 350558662368151/3528
71222368159. 350558662368268/352871222368266. 350558662368581/352871222368589.350558662368797/352871222368795. 350558662368839/35
2871222368837. 350558662368870/352871222368878. 350558662368938/352871222368936. 350558662369084/352871222369082. 350558662369092
/352871222369090. 350558662369860/352871222369868. 350558662369910/352871222369918. 350558662370421/352871222370429. 350558662370
512/352871222370510. 350558662370728/352871222370726. 350558662370850/352871222370858. 350558662370876/352871222370874. 350558662
370918/352871222370916. 350558662370975/352871222370973. 350558662371726/352871222371724. 350558662371957/352871222371955.3505586
032025002156746-2
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002156746-2
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
62371965/352871222371963. 350558662474504/352871222474502. 350558662474512/352871222474510. 350558662474538/352871222474536. 3505
58662476459/352871222476457. 350558662478018/352871222478016. 350558662478026/352871222478024. 350558662479339/352871222479337. 3
50558662479529/352871222479527. 350558662479560/352871222479568. 350558662479578/352871222479576. 350558662479586/352871222479584
. 350558662479610/352871222479618. 350558662479669/352871222479667. 350558662479677/352871222479675. 350558662479685/352871222479
683. 350558662480196/352871222480194. 350558662480204/352871222480202. 350558662480220/352871222480228. 350558662480238/352871222
480236. 350558662480279/352871222480277. 350558662480287/352871222480285. 350558662480329/352871222480327. 350558662480337/352871
222480335. 350558662480360/352871222480368. 350558662480378/352871222480376. 350558662480386/352871222480384. 350558662480394/352
871222480392. 350558662480428/352871222480426. 350558662480501/352871222480509. 350558662487613/352871222487611. 350558662487621/
352871222487629. 350558662489973/352871222489971. 350558662490757/352871222490755. 350558662490765/352871222490763. 3505586624908
07/352871222490805. 350558662490815/352871222490813. 350558662490849/352871222490847. 350558662490880/352871222490888. 3505586624
90922/352871222490920. 350558662490930/352871222490938. 350558662490963/352871222490961. 350558662491029/352871222491027. 3505586
62491235/352871222491233. 350558662491276/352871222491274. 350558662491284/352871222491282. 350558662491334/352871222491332. 3505
58662491409/352871222491407. 350558662491433/352871222491431. 350558662491698/352871222491696. 350558662491706/352871222491704. 3
50558662491805/352871222491803. 350558662491813/352871222491811.350558662491821/352871222491829. 350558662492290/352871222492298.
350558662492340/352871222492348. 350558662493686/352871222493684. 350558662493777/352871222493775. 350558662493785/3528712224937
83. 350558662493850/352871222493858. 350558662493884/352871222493882. 350558662493900/352871222493908. 350558662493918/3528712224
93916. 350558662493967/352871222493965. 350558662493991/352871222493999. 350558662494007/352871222494005. 350558662494023/3528712
22494021. 350558662494056/352871222494054. 350558662494395/352871222494393. 350558662494494/352871222494492.350558662494502/35287
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662495079/352871222495077. 350558662495087/352871222495085. 350558662495103/352871222495101. 350558662495152/352871222495150. 350
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350558662495574/352871222495572. 350558662495582/352871222495580. 350558662495608/352871222495606. 350558662495699/35287122249569
7. 350558662495772/352871222495770. 350558662495806/352871222495804. 350558662495855/352871222495853. 350558662495863/35287122249
5861. 350558662495871/352871222495879. 350558662495889/352871222495887. 350558662495905/352871222495903. 350558662495939/35287122
2495937. 350558662495954/352871222495952. 350558662496002/352871222496000. 350558662496176/352871222496174. 350558662496218/35287
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74. 350558662498800/352871222498808. 350558662498842/352871222498840. 350558662498867/352871222498865. 350558662498875/3528712224
98873. 350558662498891/352871222498899. 350558662498958/352871222498956. 350558662498982/352871222498980. 350558662499014/3528712
22499012. 350558662499022/352871222499020. 350558662499030/352871222499038. 350558662499048/352871222499046. 350558662499055/3528
71222499053. 350558662499097/352871222499095. 350558662499121/352871222499129. 350558662499139/352871222499137. 350558662499162/3
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8/352871222499236. 350558662499295/352871222499293. 350558662499311/352871222499319. 350558662499345/352871222499343. 35055866249
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88. 350558662500019/352871222500017.350558662500068/352871222500066. 350558662500290/352871222500298. 350558662500316/35287122250
0314. 350558662500332/352871222500330. 350558662500530/352871222500538. 350558662500571/352871222500579. 350558662500613/35287122
2500611. 350558662500738/352871222500736. 350558662500746/352871222500744. 350558662500761/352871222500769. 350558662500795/35287
1222500793. 350558662500811/352871222500819. 350558662500845/352871222500843. 350558662500977/352871222500975. 350558662501082/35
2871222501080. 350558662501124/352871222501122. 350558662501132/352871222501130.350558662606881/352871222606889XXXXXXXXXXXXXXXXXX
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032025002156746-2
Espacio para uso exclusivo de la Entidad Recaudadora
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