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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
032025002160440-1
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. SHAN0445415
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
9103993643
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.
156.00
72 . Peso neto kgs. dcms.
143.52
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
29.464.93
79 . Valor fletes USD
1.379.04 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
1.380.06
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: 584036-DECL: 1982736-DO: 893130725251- 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: 3105408681. ID DELIVERY: 6086097142. 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: Levante automático
No hay declaración posterior
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025002160440
133. Feha: 202512 12
134 . Levante No. 032025001881603 135 . Fecha
2025 – 12 – 17
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 92032509894261
Fecha presentación 2025-12-12 20:30:00
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 10:56:58
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002160440-1
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: 350558662229668/352871222229666. 350558662229676/352871222229674. 350558662229718/352871222229716. 350558662229734/352871
222229732. 350558662230377/352871222230375. 350558662230666/352871222230664. 350558662231508/352871222231506. 350558662231854/352
871222231852. 350558662232100/352871222232108. 350558662232282/352871222232280. 350558662232324/352871222232322. 350558662232381/
352871222232389. 350558662232407/352871222232405. 350558662232647/352871222232645. 350558662232696/352871222232694. 3505586622329
02/352871222232900. 350558662233116/352871222233114. 350558662233231/352871222233239. 350558662233769/352871222233767. 3505586622
34098/352871222234096. 350558662234130/352871222234138. 350558662234544/352871222234542. 350558662234635/352871222234633. 3505586
62234833/352871222234831. 350558662235160/352871222235168. 350558662235186/352871222235184. 350558662235541/352871222235549. 3505
58662235624/352871222235622. 350558662235632/352871222235630. 350558662235640/352871222235648. 350558662235657/352871222235655. 3
50558662235665/352871222235663. 350558662235673/352871222235671. 350558662235681/352871222235689. 350558662235699/352871222235697
. 350558662235707/352871222235705. 350558662235723/352871222235721. 350558662235731/352871222235739. 350558662235764/352871222235
762. 350558662235780/352871222235788. 350558662236002/352871222236000. 350558662236481/352871222236489. 350558662236499/352871222
236497.350558662236507/352871222236505. 350558662236572/352871222236570. 350558662236861/352871222236869. 350558662237067/3528712
22237065. 350558662237091/352871222237099. 350558662237141/352871222237149. 350558662237430/352871222237438. 350558662237448/3528
71222237446. 350558662237455/352871222237453. 350558662237505/352871222237503. 350558662237547/352871222237545. 350558662237562/3
52871222237560. 350558662237604/352871222237602. 350558662237638/352871222237636. 350558662237646/352871222237644. 35055866223765
3/352871222237651. 350558662237729/352871222237727. 350558662237745/352871222237743. 350558662237778/352871222237776. 35055866223
7893/352871222237891. 350558662237943/352871222237941. 350558662238081/352871222238089. 350558662238263/352871222238261. 35055866
2238289/352871222238287. 350558662238305/352871222238303. 350558662238313/352871222238311. 350558662238321/352871222238329. 35055
8662238339/352871222238337. 350558662238354/352871222238352. 350558662238362/352871222238360. 350558662238396/352871222238394. 35
0558662238412/352871222238410. 350558662238453/352871222238451. 350558662238479/352871222238477. 350558662238487/352871222238485.
350558662238511/352871222238519. 350558662238545/352871222238543. 350558662238578/352871222238576. 350558662238602/3528712222386
00. 350558662238636/352871222238634. 350558662238644/352871222238642. 350558662238669/352871222238667. 350558662238677/3528712222
38675. 350558662238685/352871222238683. 350558662238693/352871222238691. 350558662238701/352871222238709. 350558662238719/3528712
22238717. 350558662238727/352871222238725. 350558662238735/352871222238733. 350558662238743/352871222238741. 350558662238883/3528
71222238881. 350558662239105/352871222239103. 350558662239295/352871222239293.350558662239311/352871222239319. 350558662239329/35
2871222239327. 350558662239337/352871222239335. 350558662239550/352871222239558. 350558662239576/352871222239574. 350558662239584
/352871222239582. 350558662239600/352871222239608. 350558662239634/352871222239632. 350558662239675/352871222239673. 350558662239
725/352871222239723. 350558662239733/352871222239731. 350558662239816/352871222239814. 350558662239840/352871222239848. 350558662
239857/352871222239855. 350558662239899/352871222239897. 350558662239931/352871222239939. 350558662239949/352871222239947.3505586
62240004/352871222240002. 350558662240103/352871222240101. 350558662240111/352871222240119. 350558662240616/352871222240614. 3505
58662240871/352871222240879. 350558662240889/352871222240887. 350558662241069/352871222241067. 350558662241341/352871222241349. 3
50558662241440/352871222241448. 350558662241457/352871222241455. 350558662241515/352871222241513. 350558662242141/352871222242149
. 350558662242174/352871222242172. 350558662242471/352871222242479. 350558662242562/352871222242560. 350558662242737/352871222242
735. 350558662242851/352871222242859. 350558662242885/352871222242883. 350558662242893/352871222242891. 350558662243073/352871222
243071. 350558662243115/352871222243113. 350558662243206/352871222243204. 350558662243214/352871222243212. 350558662243255/352871
222243253. 350558662243263/352871222243261. 350558662243289/352871222243287. 350558662243487/352871222243485. 350558662243529/352
871222243527. 350558662243537/352871222243535. 350558662243545/352871222243543. 350558662243560/352871222243568. 350558662243586/
352871222243584. 350558662243594/352871222243592. 350558662243602/352871222243600. 350558662243610/352871222243618. 3505586622436
28/352871222243626. 350558662243859/352871222243857. 350558662243867/352871222243865. 350558662243917/352871222243915. 3505586622
43941/352871222243949. 350558662244055/352871222244053. 350558662244071/352871222244079. 350558662244154/352871222244152. 3505586
62244188/352871222244186. 350558662244303/352871222244301. 350558662244311/352871222244319. 350558662244329/352871222244327. 3505
58662244337/352871222244335. 350558662244345/352871222244343. 350558662244352/352871222244350. 350558662244444/352871222244442. 3
50558662244469/352871222244467. 350558662244600/352871222244608.350558662244790/352871222244798. 350558662244824/352871222244822.
350558662244832/352871222244830. 350558662244840/352871222244848. 350558662244964/352871222244962. 350558662244998/3528712222449
96. 350558662245086/352871222245084. 350558662245219/352871222245217. 350558662245649/352871222245647. 350558662245813/3528712222
45811. 350558662245854/352871222245852. 350558662245987/352871222245985. 350558662245995/352871222245993. 350558662246027/3528712
22246025. 350558662246530/352871222246538. 350558662246548/352871222246546. 350558662246555/352871222246553.350558662246605/35287
1222246603. 350558662246613/352871222246611. 350558662246886/352871222246884. 350558662246902/352871222246900. 350558662246985/35
2871222246983. 350558662247033/352871222247031. 350558662247058/352871222247056. 350558662247090/352871222247098. 350558662247108
/352871222247106. 350558662247579/352871222247577. 350558662247777/352871222247775. 350558662247876/352871222247874. 350558662247
918/352871222247916. 350558662247967/352871222247965. 350558662247975/352871222247973. 350558662248122/352871222248120. 350558662
248205/352871222248203. 350558662248288/352871222248286. 350558662248528/352871222248526. 350558662248577/352871222248575. 350558
662248593/352871222248591. 350558662248619/352871222248617. 350558662248627/352871222248625. 350558662248635/352871222248633. 350
558662248643/352871222248641. 350558662248676/352871222248674. 350558662248809/352871222248807. 350558662248825/352871222248823.
350558662248866/352871222248864. 350558662248890/352871222248898. 350558662248916/352871222248914. 350558662248965/35287122224896
3. 350558662248973/352871222248971. 350558662249070/352871222249078. 350558662249104/352871222249102. 350558662249195/35287122224
9193. 350558662249229/352871222249227. 350558662249237/352871222249235. 350558662249252/352871222249250. 350558662249310/35287122
2249318. 350558662249351/352871222249359. 350558662249369/352871222249367. 350558662249393/352871222249391. 350558662249401/35287
1222249409. 350558662249427/352871222249425. 350558662249468/352871222249466. 350558662249476/352871222249474. 350558662249575/35
2871222249573. 350558662249617/352871222249615. 350558662249682/352871222249680. 350558662249740/352871222249748. 350558662249831
/352871222249839. 350558662249849/352871222249847.350558662249872/352871222249870. 350558662249880/352871222249888. 3505586622499
14/352871222249912. 350558662249997/352871222249995. 350558662250029/352871222250027. 350558662250110/352871222250118. 3505586622
50391/352871222250399. 350558662250441/352871222250449. 350558662250482/352871222250480. 350558662250995/352871222250993. 3505586
62251084/352871222251082. 350558662251092/352871222251090. 350558662251118/352871222251116. 350558662251514/352871222251512. 3505
58662251662/352871222251660. 350558662251670/352871222251678. 350558662251787/352871222251785.350558662251811/352871222251819. 35
0558662251852/352871222251850. 350558662251878/352871222251876. 350558662251886/352871222251884. 350558662251977/352871222251975.
350558662252264/352871222252262. 350558662252579/352871222252577. 350558662252595/352871222252593. 350558662252603/3528712222526
01. 350558662252645/352871222252643. 350558662252744/352871222252742. 350558662252843/352871222252841. 350558662252884/3528712222
52882. 350558662252918/352871222252916. 350558662253023/352871222253021. 350558662253320/352871222253328. 350558662253411/3528712
22253419. 350558662253429/352871222253427. 350558662253684/352871222253682. 350558662253692/352871222253690. 350558662253700/3528
71222253708. 350558662253718/352871222253716. 350558662253726/352871222253724. 350558662253874/352871222253872. 350558662254047/3
52871222254045. 350558662254120/352871222254128. 350558662254138/352871222254136. 350558662254179/352871222254177. 35055866225421
1/352871222254219. 350558662254237/352871222254235. 350558662254252/352871222254250. 350558662254278/352871222254276. 35055866225
4294/352871222254292. 350558662254336/352871222254334. 350558662254344/352871222254342. 350558662254377/352871222254375. 35055866
032025002160440-1
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002160440-1
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
2254591/352871222254599. 350558662254617/352871222254615. 350558662254625/352871222254623. 350558662254690/352871222254698. 35055
8662254716/352871222254714. 350558662254740/352871222254748. 350558662254898/352871222254896. 350558662255002/352871222255000. 35
0558662255028/352871222255026. 350558662255127/352871222255125. 350558662255192/352871222255190. 350558662255200/352871222255208.
350558662255267/352871222255265. 350558662255275/352871222255273. 350558662255317/352871222255315. 350558662255366/3528712222553
64. 350558662255416/352871222255414.350558662255432/352871222255430. 350558662255531/352871222255539. 350558662255564/35287122225
5562. 350558662255804/352871222255802. 350558662255986/352871222255984. 350558662256117/352871222256115. 350558662256273/35287122
2256271. 350558662256497/352871222256495. 350558662256521/352871222256529. 350558662256539/352871222256537. 350558662256604/35287
1222256602. 350558662256620/352871222256628. 350558662256646/352871222256644. 350558662256745/352871222256743. 350558662256802/35
2871222256800. 350558662256885/352871222256883. 350558662256893/352871222256891.350558662256901/352871222256909. 350558662256919/
352871222256917. 350558662256927/352871222256925. 350558662256935/352871222256933. 350558662256943/352871222256941. 3505586622569
50/352871222256958. 350558662256968/352871222256966. 350558662257032/352871222257030. 350558662257040/352871222257048. 3505586622
57065/352871222257063. 350558662257081/352871222257089. 350558662257115/352871222257113. 350558662257123/352871222257121. 3505586
62257230/352871222257238. 350558662257388/352871222257386. 350558662257586/352871222257584. 350558662257602/352871222257600. 3505
58662257628/352871222257626. 350558662257644/352871222257642. 350558662257693/352871222257691. 350558662257701/352871222257709. 3
50558662257727/352871222257725. 350558662257735/352871222257733. 350558662257743/352871222257741. 350558662257768/352871222257766
. 350558662257792/352871222257790. 350558662257818/352871222257816. 350558662257826/352871222257824. 350558662257859/352871222257
857. 350558662257875/352871222257873. 350558662257891/352871222257899. 350558662257909/352871222257907. 350558662257925/352871222
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032025002160440-1
Espacio para uso exclusivo de la Entidad Recaudadora
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