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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
032025002161819-1
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. SHAN0445424
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
9103993652
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.
155.50
72 . Peso neto kgs. dcms.
143.06
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
29.469.35
79 . Valor fletes USD
1.374.62 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
1.375.64
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: 584053-DECL: 1982745-DO: 893130734251- 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: 3105409993. ID DELIVERY: 6086097839. MERCANCIA MARCA: SAMSUNG REFERENCIA: SM-A165MZADLTC, PRO
DUCTO: TELEFONO CELULAR GALAXY A16 5G Duos (CON ACCESORIOS PARA USO Y NORMAL FUNCIONAMIENTO), COLOR: GRIS, (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.: 032025000143368
Inició: 2025-12-17 11:38:33 Finalizó: 2025-12-17 19:05:00
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025002161819
133. Feha: 202512 13
134 . Levante No. 032025001886116 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 92032509901425
Fecha presentación 2025-12-13 13:46:24
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 19:40:11
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161819-1
Subpartida : 8517130000
Página 1 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
MODELO: 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: 350558662229726/352871222229724. 350558662229742/352871222229740. 350558662229759/352871222229757. 350558662229809/3528
71222229807. 350558662229916/352871222229914. 350558662229932/352871222229930. 350558662229965/352871222229963. 350558662230021/3
52871222230029. 350558662230047/352871222230045.350558662230385/352871222230383. 350558662230393/352871222230391. 350558662230609
/352871222230607. 350558662230849/352871222230847. 350558662230898/352871222230896. 350558662230906/352871222230904. 350558662231
094/352871222231092. 350558662231359/352871222231357. 350558662231417/352871222231415. 350558662231532/352871222231530. 350558662
231912/352871222231910. 350558662231995/352871222231993. 350558662232035/352871222232033. 350558662232068/352871222232066. 350558
662232316/352871222232314. 350558662232365/352871222232363. 350558662232415/352871222232413. 350558662232423/352871222232421. 350
558662232589/352871222232587. 350558662232605/352871222232603. 350558662232688/352871222232686. 350558662232811/352871222232819.
350558662232951/352871222232959. 350558662232969/352871222232967. 350558662232977/352871222232975. 350558662233009/35287122223300
7. 350558662233124/352871222233122. 350558662233132/352871222233130. 350558662233207/352871222233205. 350558662233249/35287122223
3247. 350558662233298/352871222233296. 350558662233348/352871222233346. 350558662233371/352871222233379. 350558662233504/35287122
2233502. 350558662233694/352871222233692. 350558662233702/352871222233700. 350558662233710/352871222233718. 350558662233728/35287
1222233726. 350558662233744/352871222233742. 350558662233777/352871222233775. 350558662233785/352871222233783. 350558662233801/35
2871222233809. 350558662233827/352871222233825. 350558662233892/352871222233890. 350558662233900/352871222233908. 350558662233934
/352871222233932. 350558662233942/352871222233940. 350558662234031/352871222234039. 350558662234064/352871222234062. 350558662234
072/352871222234070. 350558662234080/352871222234088. 350558662234106/352871222234104. 350558662234148/352871222234146. 350558662
234155/352871222234153. 350558662234205/352871222234203. 350558662234270/352871222234278. 350558662234296/352871222234294. 350558
662234304/352871222234302. 350558662234320/352871222234328. 350558662234353/352871222234351. 350558662234361/352871222234369. 350
558662234379/352871222234377. 350558662234536/352871222234534. 350558662234791/352871222234799. 350558662234809/352871222234807.
350558662234817/352871222234815. 350558662234825/352871222234823. 350558662234841/352871222234849. 350558662234940/35287122223494
8. 350558662235053/352871222235051.350558662235061/352871222235069. 350558662235087/352871222235085. 350558662235178/352871222235
176. 350558662235194/352871222235192. 350558662235210/352871222235218. 350558662235228/352871222235226. 350558662235244/352871222
235242. 350558662235277/352871222235275. 350558662235327/352871222235325. 350558662235442/352871222235440. 350558662235491/352871
222235499. 350558662235525/352871222235523. 350558662235590/352871222235598. 350558662235608/352871222235606. 350558662235616/352
871222235614. 350558662235772/352871222235770. 350558662235830/352871222235838.350558662235863/352871222235861. 350558662235905/3
52871222235903. 350558662235913/352871222235911. 350558662235921/352871222235929. 350558662235939/352871222235937. 35055866223595
4/352871222235952. 350558662236036/352871222236034. 350558662236044/352871222236042. 350558662236093/352871222236091. 35055866223
6119/352871222236117. 350558662236127/352871222236125. 350558662236267/352871222236265. 350558662236366/352871222236364. 35055866
2236473/352871222236471. 350558662236515/352871222236513. 350558662236564/352871222236562. 350558662236812/352871222236810. 35055
8662236895/352871222236893. 350558662236903/352871222236901. 350558662236960/352871222236968. 350558662237075/352871222237073. 35
0558662237083/352871222237081. 350558662237109/352871222237107. 350558662237117/352871222237115. 350558662237398/352871222237396.
350558662237406/352871222237404. 350558662237513/352871222237511. 350558662237521/352871222237529. 350558662237810/3528712222378
18. 350558662237828/352871222237826. 350558662237968/352871222237966. 350558662237976/352871222237974. 350558662237984/3528712222
37982. 350558662237992/352871222237990. 350558662238008/352871222238006. 350558662238016/352871222238014. 350558662238024/3528712
22238022. 350558662238107/352871222238105. 350558662238115/352871222238113. 350558662238123/352871222238121. 350558662238131/3528
71222238139. 350558662238149/352871222238147. 350558662238156/352871222238154. 350558662238164/352871222238162. 350558662238180/3
52871222238188. 350558662238214/352871222238212. 350558662238222/352871222238220. 350558662238230/352871222238238. 35055866223825
5/352871222238253. 350558662238271/352871222238279. 350558662238297/352871222238295. 350558662239063/352871222239061. 35055866223
9154/352871222239152.350558662239303/352871222239301. 350558662239444/352871222239442. 350558662239469/352871222239467. 350558662
239519/352871222239517. 350558662239626/352871222239624. 350558662239667/352871222239665. 350558662239683/352871222239681. 350558
662239691/352871222239699. 350558662239709/352871222239707. 350558662239717/352871222239715. 350558662239758/352871222239756. 350
558662239774/352871222239772. 350558662239782/352871222239780. 350558662239790/352871222239798. 350558662239915/352871222239913.
350558662240053/352871222240051. 350558662240079/352871222240077.350558662240145/352871222240143. 350558662240152/352871222240150
. 350558662240160/352871222240168. 350558662240186/352871222240184. 350558662240202/352871222240200. 350558662240236/352871222240
234. 350558662240269/352871222240267. 350558662240277/352871222240275. 350558662240285/352871222240283. 350558662240327/352871222
240325. 350558662240384/352871222240382. 350558662240392/352871222240390. 350558662240426/352871222240424. 350558662240442/352871
222240440. 350558662240483/352871222240481. 350558662240541/352871222240549. 350558662240624/352871222240622. 350558662240632/352
871222240630. 350558662240640/352871222240648. 350558662240657/352871222240655. 350558662240749/352871222240747. 350558662240764/
352871222240762. 350558662240780/352871222240788. 350558662240830/352871222240838. 350558662240848/352871222240846. 3505586622409
47/352871222240945. 350558662240954/352871222240952. 350558662240970/352871222240978. 350558662240988/352871222240986. 3505586622
41002/352871222241000. 350558662241168/352871222241166. 350558662241200/352871222241208. 350558662241218/352871222241216. 3505586
62241374/352871222241372. 350558662241382/352871222241380. 350558662241424/352871222241422. 350558662241630/352871222241638. 3505
58662241838/352871222241836. 350558662241879/352871222241877. 350558662241945/352871222241943. 350558662241978/352871222241976. 3
50558662241986/352871222241984. 350558662242042/352871222242040. 350558662242455/352871222242453. 350558662242505/352871222242503
. 350558662242513/352871222242511. 350558662242570/352871222242578. 350558662242604/352871222242602. 350558662242687/352871222242
685. 350558662242760/352871222242768. 350558662242786/352871222242784. 350558662242844/352871222242842. 350558662243008/352871222
243006.350558662243057/352871222243055. 350558662243065/352871222243063. 350558662243099/352871222243097. 350558662243164/3528712
22243162. 350558662243826/352871222243824. 350558662243834/352871222243832. 350558662243842/352871222243840. 350558662243966/3528
71222243964. 350558662244899/352871222244897. 350558662244915/352871222244913. 350558662244923/352871222244921. 350558662244931/3
52871222244939. 350558662244949/352871222244947. 350558662244956/352871222244954. 350558662244972/352871222244970. 35055866224498
0/352871222244988. 350558662245003/352871222245001.350558662245011/352871222245019. 350558662245060/352871222245068. 350558662245
714/352871222245712. 350558662245763/352871222245761. 350558662246480/352871222246488. 350558662246571/352871222246579. 350558662
246589/352871222246587. 350558662246597/352871222246595. 350558662246621/352871222246629. 350558662246647/352871222246645. 350558
662246753/352871222246751. 350558662247025/352871222247023. 350558662247041/352871222247049. 350558662247082/352871222247080. 350
558662247124/352871222247122. 350558662247157/352871222247155. 350558662247173/352871222247171. 350558662247256/352871222247254.
350558662247314/352871222247312. 350558662247330/352871222247338. 350558662247348/352871222247346. 350558662247405/35287122224740
3. 350558662247439/352871222247437. 350558662247447/352871222247445. 350558662247462/352871222247460. 350558662247488/35287122224
7486. 350558662247496/352871222247494. 350558662247850/352871222247858. 350558662247884/352871222247882. 350558662247892/35287122
2247890. 350558662247900/352871222247908. 350558662247983/352871222247981. 350558662248056/352871222248054. 350558662248064/35287
1222248062. 350558662248072/352871222248070. 350558662248106/352871222248104. 350558662248171/352871222248179. 350558662248239/35
2871222248237. 350558662248429/352871222248427. 350558662248437/352871222248435. 350558662248718/352871222248716. 350558662248734
/352871222248732. 350558662248759/352871222248757. 350558662248767/352871222248765. 350558662248783/352871222248781. 350558662248
841/352871222248849. 350558662248858/352871222248856. 350558662249088/352871222249086. 350558662249096/352871222249094. 350558662
249120/352871222249128. 350558662249153/352871222249151. 350558662249211/352871222249219. 350558662249526/352871222249524.3505586
032025002161819-1
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161819-1
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
62249542/352871222249540. 350558662249583/352871222249581. 350558662249609/352871222249607. 350558662249898/352871222249896. 3505
58662249922/352871222249920. 350558662249955/352871222249953. 350558662250003/352871222250001. 350558662250136/352871222250134. 3
50558662250227/352871222250225. 350558662250250/352871222250258. 350558662250417/352871222250415. 350558662250565/352871222250563
. 350558662250599/352871222250597. 350558662250623/352871222250621. 350558662250672/352871222250670. 350558662250706/352871222250
704. 350558662250722/352871222250720.350558662250730/352871222250738. 350558662250847/352871222250845. 350558662250862/3528712222
50860. 350558662250912/352871222250910. 350558662250920/352871222250928. 350558662250938/352871222250936. 350558662250961/3528712
22250969. 350558662251068/352871222251066. 350558662251282/352871222251280. 350558662251365/352871222251363. 350558662251381/3528
71222251389. 350558662251415/352871222251413. 350558662251449/352871222251447. 350558662251464/352871222251462. 350558662251480/3
52871222251488. 350558662251506/352871222251504. 350558662251720/352871222251728. 350558662251753/352871222251751. 35055866225184
5/352871222251843. 350558662251944/352871222251942. 350558662252017/352871222252015. 350558662252249/352871222252247. 35055866225
2272/352871222252270. 350558662252322/352871222252320. 350558662252355/352871222252353. 350558662252504/352871222252502. 35055866
2252512/352871222252510. 350558662252553/352871222252551. 350558662252785/352871222252783. 350558662252827/352871222252825. 35055
8662253379/352871222253377. 350558662253395/352871222253393. 350558662253437/352871222253435. 350558662253627/352871222253625. 35
0558662253676/352871222253674. 350558662253825/352871222253823. 350558662253890/352871222253898. 350558662254005/352871222254003.
350558662254070/352871222254078. 350558662254450/352871222254458. 350558662254484/352871222254482. 350558662254492/3528712222544
90. 350558662254526/352871222254524. 350558662254567/352871222254565. 350558662254773/352871222254771. 350558662254807/3528712222
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22255018. 350558662255051/352871222255059. 350558662255135/352871222255133. 350558662255176/352871222255174.350558662255184/35287
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246. 350558662257263/352871222257261. 350558662257289/352871222257287. 350558662257297/352871222257295. 350558662257354/352871222
257352. 350558662257461/352871222257469. 350558662257883/352871222257881. 350558662257958/352871222257956. 350558662257966/352871
222257964. 350558662257982/352871222257980. 350558662257990/352871222257998. 350558662258014/352871222258012. 350558662258030/352
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352871222258095. 350558662258139/352871222258137. 350558662258154/352871222258152. 350558662258162/352871222258160. 3505586622581
70/352871222258178. 350558662258188/352871222258186. 350558662258196/352871222258194. 350558662258220/352871222258228. 3505586622
58238/352871222258236. 350558662258402/352871222258400. 350558662258725/352871222258723. 350558662258733/352871222258731. 3505586
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0558662261455/352871222261453. 350558662261539/352871222261537. 350558662261554/352871222261552. 350558662261588/352871222261586.
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51. 350558662261661/352871222261669. 350558662261679/352871222261677. 350558662261695/352871222261693. 350558662261703/3528712222
61701. 350558662261711/352871222261719. 350558662261729/352871222261727. 350558662261745/352871222261743. 350558662261760/3528712
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/352871222261925. 350558662261976/352871222261974. 350558662261992/352871222261990. 350558662262008/352871222262006. 350558662262
024/352871222262022. 350558662262032/352871222262030. 350558662262073/352871222262071. 350558662262479/352871222262477. 350558662
262578/352871222262576. 350558662262628/352871222262626. 350558662262644/352871222262642. 350558662262651/352871222262659. 350558
662262834/352871222262832. 350558662263261/352871222263269. 350558662263287/352871222263285. 350558662263584/352871222263582. 350
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350558662263766/352871222263764. 350558662263774/352871222263772. 350558662263790/352871222263798. 350558662263808/35287122226380
6. 350558662264178/352871222264176. 350558662264186/352871222264184. 350558662264202/352871222264200. 350558662264244/35287122226
4242. 350558662264251/352871222264259. 350558662264319/352871222264317. 350558662264327/352871222264325. 350558662264343/35287122
2264341. 350558662264756/352871222264754. 350558662265498/352871222265496. 350558662605461/352871222605469. 350558662606535/35287
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2871222606632. 350558662606642/352871222606640. 350558662606659/352871222606657.350558662606683/352871222606681XXXXXXXXXXXXXXXXXX
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032025002161819-1
Espacio para uso exclusivo de la Entidad Recaudadora
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