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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
032025002161834-2
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. SHAN0445426
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
9103993654
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: 584090-DECL: 1982855-DO: 893130736251- 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: 3105410221. ID DELIVERY: 6086096761. 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: Levante automático
No hay declaración posterior
131 . Espacio reservado uso exclusivo Ministerio de Relaciones Exteriores 132 . No. Aceptación declaración
032025002161834
133. Feha: 202512 13
134 . Levante No. 032025001881970 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 92032509901464
Fecha presentación 2025-12-13 13:48:00
Valor pagado $0.00
Fecha de Impresión: 2025-12-17 11:40:22
Page 1
SEC
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161834-2
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: 350558662050155/352871222050153. 350558662050171/352871222050179. 350558662050247/352871222050245. 350558662050254/3528
71222050252. 350558662050296/352871222050294. 350558662050304/352871222050302. 350558662050312/352871222050310. 350558662050320/3
52871222050328. 350558662050353/352871222050351.350558662050361/352871222050369. 350558662050403/352871222050401. 350558662050452
/352871222050450. 350558662050478/352871222050476. 350558662050486/352871222050484. 350558662050502/352871222050500. 350558662050
510/352871222050518. 350558662050528/352871222050526. 350558662050536/352871222050534. 350558662050551/352871222050559. 350558662
050593/352871222050591. 350558662050601/352871222050609. 350558662050643/352871222050641. 350558662050650/352871222050658. 350558
662050668/352871222050666. 350558662050676/352871222050674. 350558662050692/352871222050690. 350558662050726/352871222050724. 350
558662050742/352871222050740. 350558662050759/352871222050757. 350558662050767/352871222050765. 350558662050775/352871222050773.
350558662050791/352871222050799. 350558662050809/352871222050807. 350558662050841/352871222050849. 350558662050858/35287122205085
6. 350558662050874/352871222050872. 350558662050890/352871222050898. 350558662050916/352871222050914. 350558662050924/35287122205
0922. 350558662050932/352871222050930. 350558662050957/352871222050955. 350558662050965/352871222050963. 350558662050973/35287122
2050971. 350558662050981/352871222050989. 350558662050999/352871222050997. 350558662051005/352871222051003. 350558662051013/35287
1222051011. 350558662051021/352871222051029. 350558662051039/352871222051037. 350558662051047/352871222051045. 350558662051112/35
2871222051110. 350558662051245/352871222051243. 350558662051302/352871222051300. 350558662051328/352871222051326. 350558662051351
/352871222051359. 350558662051369/352871222051367. 350558662051377/352871222051375. 350558662051385/352871222051383. 350558662051
401/352871222051409. 350558662051419/352871222051417. 350558662051427/352871222051425. 350558662051443/352871222051441. 350558662
051450/352871222051458. 350558662051468/352871222051466. 350558662051476/352871222051474. 350558662051484/352871222051482. 350558
662051492/352871222051490. 350558662051500/352871222051508. 350558662051526/352871222051524. 350558662051534/352871222051532. 350
558662051542/352871222051540. 350558662051575/352871222051573. 350558662051583/352871222051581. 350558662051880/352871222051888.
350558662051898/352871222051896. 350558662051906/352871222051904. 350558662051914/352871222051912. 350558662051930/35287122205193
8. 350558662052029/352871222052027.350558662052060/352871222052068. 350558662052078/352871222052076. 350558662052102/352871222052
100. 350558662052128/352871222052126. 350558662052136/352871222052134. 350558662052144/352871222052142. 350558662052151/352871222
052159. 350558662052169/352871222052167. 350558662052177/352871222052175. 350558662052193/352871222052191. 350558662052201/352871
222052209. 350558662052219/352871222052217. 350558662052227/352871222052225. 350558662052235/352871222052233. 350558662052243/352
871222052241. 350558662052250/352871222052258. 350558662052268/352871222052266.350558662052276/352871222052274. 350558662052292/3
52871222052290. 350558662052334/352871222052332. 350558662052375/352871222052373. 350558662052409/352871222052407. 35055866205241
7/352871222052415. 350558662052425/352871222052423. 350558662052466/352871222052464. 350558662052474/352871222052472. 35055866205
2482/352871222052480. 350558662052508/352871222052506. 350558662052524/352871222052522. 350558662052540/352871222052548. 35055866
2052557/352871222052555. 350558662052565/352871222052563. 350558662052573/352871222052571. 350558662052581/352871222052589. 35055
8662052854/352871222052852. 350558662052870/352871222052878. 350558662052888/352871222052886. 350558662052896/352871222052894. 35
0558662052904/352871222052902. 350558662052912/352871222052910. 350558662052920/352871222052928. 350558662052946/352871222052944.
350558662052953/352871222052951. 350558662052961/352871222052969. 350558662052979/352871222052977. 350558662052995/3528712220529
93. 350558662053001/352871222053009. 350558662053019/352871222053017. 350558662053027/352871222053025. 350558662053035/3528712220
53033. 350558662053043/352871222053041. 350558662053050/352871222053058. 350558662053126/352871222053124. 350558662053134/3528712
22053132. 350558662053167/352871222053165. 350558662053266/352871222053264. 350558662053274/352871222053272. 350558662053282/3528
71222053280. 350558662053373/352871222053371. 350558662053415/352871222053413. 350558662053431/352871222053439. 350558662053449/3
52871222053447. 350558662053456/352871222053454. 350558662053464/352871222053462. 350558662053472/352871222053470. 35055866205348
0/352871222053488. 350558662053498/352871222053496. 350558662053506/352871222053504. 350558662053514/352871222053512. 35055866205
3738/352871222053736.350558662053795/352871222053793. 350558662053803/352871222053801. 350558662053829/352871222053827. 350558662
053837/352871222053835. 350558662053852/352871222053850. 350558662053860/352871222053868. 350558662053878/352871222053876. 350558
662053910/352871222053918. 350558662053928/352871222053926. 350558662053944/352871222053942. 350558662053951/352871222053959. 350
558662053977/352871222053975. 350558662053985/352871222053983. 350558662053993/352871222053991. 350558662054009/352871222054007.
350558662054017/352871222054015. 350558662054025/352871222054023.350558662054033/352871222054031. 350558662054041/352871222054049
. 350558662054058/352871222054056. 350558662054066/352871222054064. 350558662054074/352871222054072. 350558662054082/352871222054
080. 350558662054090/352871222054098. 350558662054116/352871222054114. 350558662054140/352871222054148. 350558662054157/352871222
054155. 350558662054181/352871222054189. 350558662054199/352871222054197. 350558662054207/352871222054205. 350558662054223/352871
222054221. 350558662054249/352871222054247. 350558662054256/352871222054254. 350558662054272/352871222054270. 350558662054280/352
871222054288. 350558662054306/352871222054304. 350558662054322/352871222054320. 350558662054355/352871222054353. 350558662054371/
352871222054379. 350558662054389/352871222054387. 350558662054397/352871222054395. 350558662054413/352871222054411. 3505586620544
39/352871222054437. 350558662054454/352871222054452. 350558662054462/352871222054460. 350558662054470/352871222054478. 3505586620
54504/352871222054502. 350558662054512/352871222054510. 350558662054520/352871222054528. 350558662054553/352871222054551. 3505586
62054595/352871222054593. 350558662054603/352871222054601. 350558662054645/352871222054643. 350558662054678/352871222054676. 3505
58662054702/352871222054700. 350558662054710/352871222054718. 350558662054736/352871222054734. 350558662054744/352871222054742. 3
50558662054769/352871222054767. 350558662054819/352871222054817. 350558662054843/352871222054841. 350558662054850/352871222054858
. 350558662054876/352871222054874. 350558662054884/352871222054882. 350558662054892/352871222054890. 350558662054900/352871222054
908. 350558662054918/352871222054916. 350558662054926/352871222054924. 350558662054934/352871222054932. 350558662055147/352871222
055145.350558662055196/352871222055194. 350558662055261/352871222055269. 350558662055287/352871222055285. 350558662055345/3528712
22055343. 350558662055402/352871222055400. 350558662055410/352871222055418. 350558662055436/352871222055434. 350558662055444/3528
71222055442. 350558662055469/352871222055467. 350558662055485/352871222055483. 350558662055493/352871222055491. 350558662055501/3
52871222055509. 350558662055519/352871222055517. 350558662055535/352871222055533. 350558662055568/352871222055566. 35055866205558
4/352871222055582. 350558662055592/352871222055590.350558662055931/352871222055939. 350558662055956/352871222055954. 350558662055
972/352871222055970. 350558662056020/352871222056028. 350558662056053/352871222056051. 350558662056061/352871222056069. 350558662
056103/352871222056101. 350558662056129/352871222056127. 350558662056137/352871222056135. 350558662056145/352871222056143. 350558
662056152/352871222056150. 350558662056160/352871222056168. 350558662056178/352871222056176. 350558662056186/352871222056184. 350
558662056202/352871222056200. 350558662056210/352871222056218. 350558662056228/352871222056226. 350558662056236/352871222056234.
350558662056244/352871222056242. 350558662056251/352871222056259. 350558662056269/352871222056267. 350558662056277/35287122205627
5. 350558662056285/352871222056283. 350558662056293/352871222056291. 350558662056301/352871222056309. 350558662056319/35287122205
6317. 350558662056327/352871222056325. 350558662056335/352871222056333. 350558662056343/352871222056341. 350558662056350/35287122
2056358. 350558662056376/352871222056374. 350558662056392/352871222056390. 350558662056418/352871222056416. 350558662056434/35287
1222056432. 350558662056467/352871222056465. 350558662056483/352871222056481. 350558662056491/352871222056499. 350558662056525/35
2871222056523. 350558662056541/352871222056549. 350558662056566/352871222056564. 350558662056590/352871222056598. 350558662056608
/352871222056606. 350558662056616/352871222056614. 350558662056632/352871222056630. 350558662056657/352871222056655. 350558662056
665/352871222056663. 350558662056673/352871222056671. 350558662056681/352871222056689. 350558662056699/352871222056697. 350558662
056707/352871222056705. 350558662056715/352871222056713. 350558662056723/352871222056721. 350558662056749/352871222056747.3505586
032025002161834-2
Espacio para uso exclusivo de la Entidad Recaudadora
Page 2
REPÚBLICA DE COLOMBIA
Declaración de Importación
Aceptación : 032025002161834-2
Subpartida : 8517130000
Página 2 de 2
105. Continuación descripción mercancías (Incluya marcas, seriales y otros)
62056756/352871222056754. 350558662056764/352871222056762. 350558662056780/352871222056788. 350558662056798/352871222056796. 3505
58662056806/352871222056804. 350558662056814/352871222056812. 350558662056822/352871222056820. 350558662056830/352871222056838. 3
50558662056905/352871222056903. 350558662056947/352871222056945. 350558662056954/352871222056952. 350558662056970/352871222056978
. 350558662056996/352871222056994. 350558662057028/352871222057026. 350558662057077/352871222057075. 350558662057127/352871222057
125. 350558662057135/352871222057133.350558662057150/352871222057158. 350558662057168/352871222057166. 350558662057176/3528712220
57174. 350558662057192/352871222057190. 350558662057200/352871222057208. 350558662057226/352871222057224. 350558662057424/3528712
22057422. 350558662057465/352871222057463. 350558662057499/352871222057497. 350558662057507/352871222057505. 350558662057556/3528
71222057554. 350558662057564/352871222057562. 350558662057572/352871222057570. 350558662057580/352871222057588. 350558662057663/3
52871222057661. 350558662057671/352871222057679. 350558662057705/352871222057703. 350558662057713/352871222057711. 35055866205772
1/352871222057729. 350558662057929/352871222057927. 350558662057937/352871222057935. 350558662057994/352871222057992. 35055866205
8000/352871222058008. 350558662058034/352871222058032. 350558662058042/352871222058040. 350558662058059/352871222058057. 35055866
2058083/352871222058081. 350558662058091/352871222058099. 350558662058109/352871222058107. 350558662058117/352871222058115. 35055
8662058125/352871222058123. 350558662058133/352871222058131. 350558662058141/352871222058149. 350558662058158/352871222058156. 35
0558662058166/352871222058164. 350558662058174/352871222058172. 350558662058182/352871222058180. 350558662058190/352871222058198.
350558662058208/352871222058206. 350558662058216/352871222058214. 350558662058224/352871222058222. 350558662058232/3528712220582
30. 350558662058240/352871222058248. 350558662058257/352871222058255. 350558662058299/352871222058297. 350558662058323/3528712220
58321. 350558662058398/352871222058396. 350558662058406/352871222058404. 350558662058430/352871222058438. 350558662058448/3528712
22058446. 350558662058455/352871222058453. 350558662058471/352871222058479. 350558662058489/352871222058487.350558662058505/35287
1222058503. 350558662058539/352871222058537. 350558662058588/352871222058586. 350558662058596/352871222058594. 350558662058638/35
2871222058636. 350558662058646/352871222058644. 350558662058661/352871222058669. 350558662058893/352871222058891. 350558662059073
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032025002161834-2
Espacio para uso exclusivo de la Entidad Recaudadora
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