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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
032025002160461-4
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. SHAN0445416
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
9103993644
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: 584044-DECL: 1982740-DO: 893130726251- 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: 3105408682. ID DELIVERY: 6086096094. 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
032025002160461
133. Feha: 202512 12
134 . Levante No. 032025001881660 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 92032509894363
Fecha presentación 2025-12-12 20:47:51
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 10:59:53
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002160461-4
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: 350558662050270/352871222050278. 350558662050882/352871222050880. 350558662051062/352871222051060. 350558662051096/352871
222051094. 350558662051278/352871222051276. 350558662052045/352871222052043. 350558662052052/352871222052050. 350558662052490/352
871222052498. 350558662054777/352871222054775. 350558662054793/352871222054791. 350558662054975/352871222054973. 350558662057218/
352871222057216. 350558662057390/352871222057398. 350558662057457/352871222057455. 350558662057853/352871222057851. 3505586620579
03/352871222057901. 350558662057911/352871222057919. 350558662058968/352871222058966. 350558662107849/352871222107847. 3505586621
69690/352871222169698. 350558662169732/352871222169730. 350558662229791/352871222229799. 350558662229841/352871222229849. 3505586
62229957/352871222229955. 350558662229981/352871222229989. 350558662230310/352871222230318. 350558662230963/352871222230961. 3505
58662231045/352871222231043. 350558662231391/352871222231399. 350558662232084/352871222232082. 350558662232399/352871222232397. 3
50558662232738/352871222232736. 350558662233264/352871222233262. 350558662233355/352871222233353. 350558662233751/352871222233759
. 350558662233850/352871222233858. 350558662233884/352871222233882. 350558662234049/352871222234047. 350558662234569/352871222234
567. 350558662234577/352871222234575. 350558662234601/352871222234609. 350558662234684/352871222234682. 350558662234734/352871222
234732.350558662235301/352871222235309. 350558662235319/352871222235317. 350558662235426/352871222235424. 350558662235459/3528712
22235457. 350558662235475/352871222235473. 350558662235483/352871222235481. 350558662235509/352871222235507. 350558662235517/3528
71222235515. 350558662235533/352871222235531. 350558662235558/352871222235556. 350558662235566/352871222235564. 350558662235574/3
52871222235572. 350558662235582/352871222235580. 350558662235756/352871222235754. 350558662235806/352871222235804. 35055866223581
4/352871222235812. 350558662235822/352871222235820. 350558662235848/352871222235846. 350558662235855/352871222235853. 35055866223
5889/352871222235887. 350558662235962/352871222235960. 350558662236135/352871222236133. 350558662236143/352871222236141. 35055866
2236259/352871222236257. 350558662236465/352871222236463. 350558662236648/352871222236646. 350558662237026/352871222237024. 35055
8662237034/352871222237032. 350558662237133/352871222237131. 350558662237281/352871222237289. 350558662237299/352871222237297. 35
0558662237307/352871222237305. 350558662237422/352871222237420. 350558662237463/352871222237461. 350558662237570/352871222237578.
350558662237588/352871222237586. 350558662237786/352871222237784. 350558662237794/352871222237792. 350558662237802/3528712222378
00. 350558662237836/352871222237834. 350558662238099/352871222238097. 350558662238347/352871222238345. 350558662238420/3528712222
38428. 350558662238529/352871222238527. 350558662238552/352871222238550. 350558662238560/352871222238568. 350558662238792/3528712
22238790. 350558662238834/352871222238832. 350558662238859/352871222238857. 350558662238867/352871222238865. 350558662238933/3528
71222238931. 350558662238958/352871222238956. 350558662239055/352871222239053.350558662239071/352871222239079. 350558662239097/35
2871222239095. 350558662239113/352871222239111. 350558662239121/352871222239129. 350558662239139/352871222239137. 350558662239147
/352871222239145. 350558662239188/352871222239186. 350558662239196/352871222239194. 350558662239212/352871222239210. 350558662239
246/352871222239244. 350558662239253/352871222239251. 350558662239279/352871222239277. 350558662239352/352871222239350. 350558662
239824/352871222239822. 350558662240038/352871222240036. 350558662240095/352871222240093. 350558662240210/352871222240218.3505586
62240228/352871222240226. 350558662240244/352871222240242. 350558662240293/352871222240291. 350558662240319/352871222240317. 3505
58662240335/352871222240333. 350558662240343/352871222240341. 350558662240350/352871222240358. 350558662240368/352871222240366. 3
50558662240376/352871222240374. 350558662240509/352871222240507. 350558662240525/352871222240523. 350558662240608/352871222240606
. 350558662240673/352871222240671. 350558662240699/352871222240697. 350558662240756/352871222240754. 350558662240798/352871222240
796. 350558662240897/352871222240895. 350558662240905/352871222240903. 350558662240913/352871222240911. 350558662241010/352871222
241018. 350558662241028/352871222241026. 350558662241036/352871222241034. 350558662241184/352871222241182. 350558662241192/352871
222241190. 350558662241366/352871222241364. 350558662241408/352871222241406. 350558662241416/352871222241414. 350558662241465/352
871222241463. 350558662241473/352871222241471. 350558662241705/352871222241703. 350558662241952/352871222241950. 350558662242091/
352871222242099. 350558662242372/352871222242370. 350558662242661/352871222242669. 350558662242802/352871222242800. 3505586622428
28/352871222242826. 350558662242935/352871222242933. 350558662242950/352871222242958. 350558662242984/352871222242982. 3505586622
42992/352871222242990. 350558662243081/352871222243089. 350558662243107/352871222243105. 350558662243131/352871222243139. 3505586
62243156/352871222243154. 350558662243198/352871222243196. 350558662243248/352871222243246. 350558662243339/352871222243337. 3505
58662243370/352871222243378. 350558662243388/352871222243386. 350558662243396/352871222243394. 350558662243412/352871222243410. 3
50558662243438/352871222243436. 350558662243453/352871222243451.350558662243479/352871222243477. 350558662243651/352871222243659.
350558662243677/352871222243675. 350558662243750/352871222243758. 350558662243768/352871222243766. 350558662243784/3528712222437
82. 350558662243925/352871222243923. 350558662243933/352871222243931. 350558662243982/352871222243980. 350558662244014/3528712222
44012. 350558662244022/352871222244020. 350558662244030/352871222244038. 350558662244063/352871222244061. 350558662244121/3528712
22244129. 350558662244170/352871222244178. 350558662244212/352871222244210. 350558662244220/352871222244228.350558662244485/35287
1222244483. 350558662244501/352871222244509. 350558662244576/352871222244574. 350558662244592/352871222244590. 350558662244618/35
2871222244616. 350558662244634/352871222244632. 350558662244667/352871222244665. 350558662244683/352871222244681. 350558662244733
/352871222244731. 350558662244758/352871222244756. 350558662244766/352871222244764. 350558662244782/352871222244780. 350558662244
907/352871222244905. 350558662245078/352871222245076. 350558662245128/352871222245126. 350558662245136/352871222245134. 350558662
245227/352871222245225. 350558662245250/352871222245258. 350558662245359/352871222245357. 350558662245367/352871222245365. 350558
662245524/352871222245522. 350558662245581/352871222245589. 350558662245599/352871222245597. 350558662245615/352871222245613. 350
558662245664/352871222245662. 350558662245680/352871222245688. 350558662245698/352871222245696. 350558662245722/352871222245720.
350558662245730/352871222245738. 350558662245748/352871222245746. 350558662245755/352871222245753. 350558662245979/35287122224597
7. 350558662246019/352871222246017. 350558662246084/352871222246082. 350558662246118/352871222246116. 350558662246126/35287122224
6124. 350558662246357/352871222246355. 350558662246472/352871222246470. 350558662246514/352871222246512. 350558662246522/35287122
2246520. 350558662246563/352871222246561. 350558662246845/352871222246843. 350558662246936/352871222246934. 350558662246993/35287
1222246991. 350558662247009/352871222247007. 350558662247017/352871222247015. 350558662247066/352871222247064. 350558662247181/35
2871222247189. 350558662247223/352871222247221. 350558662248312/352871222248310. 350558662248346/352871222248344. 350558662248353
/352871222248351. 350558662248387/352871222248385.350558662248395/352871222248393. 350558662248403/352871222248401. 3505586622484
60/352871222248468. 350558662248486/352871222248484. 350558662248494/352871222248492. 350558662248569/352871222248567. 3505586622
49054/352871222249052. 350558662250045/352871222250043. 350558662250755/352871222250753. 350558662250870/352871222250878. 3505586
62250904/352871222250902. 350558662250946/352871222250944. 350558662250953/352871222250951. 350558662251688/352871222251686. 3505
58662251951/352871222251959. 350558662252025/352871222252023. 350558662252280/352871222252288.350558662252298/352871222252296. 35
0558662252330/352871222252338. 350558662252371/352871222252379. 350558662252587/352871222252585. 350558662252678/352871222252676.
350558662252769/352871222252767. 350558662252793/352871222252791. 350558662252850/352871222252858. 350558662252983/3528712222529
81. 350558662253007/352871222253005. 350558662253551/352871222253559. 350558662254153/352871222254151. 350558662254203/3528712222
54201. 350558662254229/352871222254227. 350558662254286/352871222254284. 350558662254401/352871222254409. 350558662254435/3528712
22254433. 350558662254476/352871222254474. 350558662254500/352871222254508. 350558662254534/352871222254532. 350558662254542/3528
71222254540. 350558662254559/352871222254557. 350558662254757/352871222254755. 350558662254781/352871222254789. 350558662254799/3
52871222254797. 350558662254815/352871222254813. 350558662254823/352871222254821. 350558662254864/352871222254862. 35055866225487
2/352871222254870. 350558662254880/352871222254888. 350558662254906/352871222254904. 350558662254922/352871222254920. 35055866225
4948/352871222254946. 350558662254989/352871222254987. 350558662255044/352871222255042. 350558662255168/352871222255166. 35055866
032025002160461-4
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002160461-4
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
2255242/352871222255240. 350558662255291/352871222255299. 350558662255309/352871222255307. 350558662255440/352871222255448. 35055
8662256042/352871222256040. 350558662256059/352871222256057. 350558662256224/352871222256222. 350558662256430/352871222256438. 35
0558662256828/352871222256826. 350558662256836/352871222256834. 350558662256844/352871222256842. 350558662256851/352871222256859.
350558662256877/352871222256875. 350558662256976/352871222256974. 350558662256984/352871222256982. 350558662257057/3528712222570
55. 350558662257073/352871222257071.350558662257099/352871222257097. 350558662257149/352871222257147. 350558662257172/35287122225
7170. 350558662257396/352871222257394. 350558662257404/352871222257402. 350558662257412/352871222257410. 350558662257438/35287122
2257436. 350558662257446/352871222257444. 350558662257453/352871222257451. 350558662257487/352871222257485. 350558662257495/35287
1222257493. 350558662257503/352871222257501. 350558662257511/352871222257519. 350558662257537/352871222257535. 350558662257545/35
2871222257543. 350558662257552/352871222257550. 350558662257636/352871222257634.350558662257651/352871222257659. 350558662257719/
352871222257717. 350558662257784/352871222257782. 350558662257974/352871222257972. 350558662258006/352871222258004. 3505586622580
22/352871222258020. 350558662258048/352871222258046. 350558662258063/352871222258061. 350558662258105/352871222258103. 3505586622
58113/352871222258111. 350558662258212/352871222258210. 350558662258378/352871222258376. 350558662258527/352871222258525. 3505586
62258543/352871222258541. 350558662258717/352871222258715. 350558662258980/352871222258988. 350558662259244/352871222259242. 3505
58662259251/352871222259259. 350558662259269/352871222259267. 350558662259293/352871222259291. 350558662259319/352871222259317. 3
50558662259350/352871222259358. 350558662259368/352871222259366. 350558662259459/352871222259457. 350558662259483/352871222259481
. 350558662259772/352871222259770. 350558662259871/352871222259879. 350558662259889/352871222259887. 350558662260028/352871222260
026. 350558662260101/352871222260109. 350558662260127/352871222260125. 350558662260168/352871222260166. 350558662260184/352871222
260182. 350558662260242/352871222260240. 350558662260291/352871222260299. 350558662260721/352871222260729. 350558662260747/352871
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352871222261115. 350558662261133/352871222261131. 350558662261158/352871222261156. 350558662261208/352871222261206. 3505586622612
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61505/352871222261503.350558662261521/352871222261529. 350558662261943/352871222261941. 350558662261950/352871222261958. 35055866
2261968/352871222261966. 350558662262016/352871222262014. 350558662262081/352871222262089. 350558662262156/352871222262154. 35055
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350558662262388/352871222262386. 350558662262396/352871222262394.350558662262453/352871222262451. 350558662262545/35287122226254
3. 350558662262610/352871222262618. 350558662262677/352871222262675. 350558662262685/352871222262683. 350558662262750/35287122226
2758. 350558662262818/352871222262816. 350558662262859/352871222262857. 350558662262875/352871222262873. 350558662262891/35287122
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263675/352871222263673. 350558662263758/352871222263756. 350558662263857/352871222263855. 350558662263899/352871222263897. 350558
662263923/352871222263921. 350558662263949/352871222263947. 350558662263964/352871222263962. 350558662263972/352871222263970. 350
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4. 350558662264434/352871222264432. 350558662264459/352871222264457. 350558662264467/352871222264465. 350558662264483/35287122226
4481. 350558662264491/352871222264499. 350558662264509/352871222264507. 350558662264533/352871222264531. 350558662264541/35287122
2264549.350558662264558/352871222264556. 350558662264590/352871222264598. 350558662264632/352871222264630. 350558662264657/352871
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352871222265082. 350558662265092/352871222265090. 350558662265100/352871222265108. 350558662265118/352871222265116. 3505586622651
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350558662336190/352871222336198. 350558662336265/352871222336263. 350558662336281/352871222336289. 350558662336307/3528712223363
05. 350558662336349/352871222336347. 350558662336356/352871222336354. 350558662336489/352871222336487. 350558662336497/3528712223
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71222606590. 350558662606717/352871222606715. 350558662606741/352871222606749. 350558662606782/352871222606780XXXXXXXXXXXXXXXXXXX
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032025002160461-4
Espacio para uso exclusivo de la Entidad Recaudadora
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